Day 7 and 8 (for Final Exam) Flashcards
1 cause of death during pregnancy is
homicide from intimate partner violence
Partner Violence Screening Tool
Have you been hit, kicked, punched, or otherwise hurt by someone in the past year?
Do you feel safe in your current relationship?
Is there a partner from a previous relationship who is making you feel unsafe now?
Retinoblastoma
“Red reflex”
Malignancy of retina
Unilateral or bilateral (25%)
Autosomal dominant gene in 40% of children
Treatment of Retinoblastoma
Chemotherapy, Radiation, Laser photo-coagulation
Surgery -> enucleation
What maternal infections cause congenital cataracts?
RR - rubella (the most common cause), rubeola
HH - herpes simplex, herpes zoster
CC - chicken pox, cytomegalovirus
poliomyelitis, influenza, Epstein-Barr virus, syphilis and toxoplasmosis.
What’s the treatment for congenital cataracts?
tetracycline antibiotics
Whats the most common cause of congenital cataracts?
maternal rubella infection
Choanal Atresia
Nasal passages are blocked by bone, soft tissue
70% are unilateral
Most are not dx at delivery
If bilateral respiratory distress
What is the treatment for Choanal Atresia
Stents are placed in nares
Nursing Interventions for cleft lip/palate
Respiratory status Feeding behaviors Parent/infant interactions - bonding Skin integrity, Oral hygiene Prevention of Infection
Treatment for cleft lip/palate
Surgery, based on severity
Modified feeding techniques or devices
ESSR for feeding difficulties
E = Enlarge the nipple S = Stimulate the suck reflex S = Swallow fluid appropriately R = Rest when infant signals with facial expression
Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)
Esophagus and trachea do not develop as parallel tracts
Esophagus ends as either:
- Blind pouch
- Connected to trachea by a fistula
TEF and EA Clinical Manifestations
***Excessive salivation and drooling: frothy mucus
Apnea
Respiratory distress after eating
Abdominal distention
“The Three C’s” of TEF and EA
coughing, choking, cyanosis
Diagnostic testing and treatment plan for TEF and EA
CXR -> radio-opaque or
Pediatric surgeon: endoscopy or bronchoscopy
Nursing Diagnoses for 1 day old with TEF
- Ineffective Airway Clearance
- Risk for aspiration
- Impaired gas exchange
- FVD
- Interrupted family processes
- Deficient knowledge
Abdominal wall defects: Two variations of abdominal hernias
Omphalacele and Gastroschisis
Omphalacele
Intra-abdominal contents herniate through umbilical cord
Covered with peritoneal membrane
Gastroschisis
Abdominal organs herniate through abdominal wall
Not covered with peritoneal membrane
4 types of Anorectal Malformations
Anal stenosis - narrowing
Anal atresia - absent -> blind pouch or fistulas
Imperforate anus - blind pouch or membrane
Fistula – recto-urethra, recto-vaginal, recto…
Anorectal Malformations are considered ___ congenital defects
Common
Biliary Atresia - what is it, and what are the 4 things is can lead to?
- Absence or constriction of common bile duct
- Bile cannot flow from liver into duodenum
- Results in: Cholestasis Fibrosis Cirrhosis Death
Clinical Manifestations of Biliary Atresia
- Bile backup in liver:
Inflammation, edema, hepatic degeneration
Malabsorption of fats and vitamins - Jaundice
- Dark urine
- ***Alcoholic stools
- Weight loss
- Irritability
- Enlarged liver and abdomen
Cystic fibrosis
Impermeable Epithelial Cells
a hereditary disorder characterized by
lung congestion and infection and malabsorption of nutrients.
excessive mucous production in bronchioles… ..and in pancreas, bile ducts, and small intestine
CFTR gene:
Autosomal Recessive
Both parents contribute the altered gene
Each pregnancy has 25% chance of developing altered gene
Higher incidence in Caucasians and Ashkenazi Jews.
What may be the first sign of cystic fibrosis? That and what other initial symptoms?
meconium ileus
steatorrhea - bulky, frothy, foul-smelling stool
Prenatal Factors associated with CHD (4)
Maternal insulin-dependent diabetes
Maternal rubella
Maternal alcoholism
Maternal age > 40 yrs
Genetic Factors associated with CHD (4)
Chromosomal – 50% risk Down Syndrome
Sibling with heart defect
Parent with CHD
Other non-cardiac congenital anomalies
Diagnosing Heart Anomalies
ECHO
Cardiac Catheterization
Congenital Heart Defects associated with Increased Pulmonary Blood Flow (Acyanotic)
**VSD
**ASD
**PDA
AVC
Congenital Heart Defects associated with Obstructed Blood Flow (Acyanotic)
**COA
AS
Congenital Heart Defects associated with Decreased Pulmonary Blood Flow (Cyanotic)
TOF
PS
T/PA
Congenital Heart Defects associated with Mixed Blood Flow (Cyanotic)
***TGA
HLHS
TAPVR
TA
Ventricular Septal Defect
Small or large opening in septum between left and right ventricles
Left to right shunting
Ventricular Septal Defect clinical presentation and assessment
Tachypnea, dyspnea
Poor growth, reduced fluid intake
Frequent respiratory infections
Onset of Heart Failure
Atrial Septal Defect
Small or large opening in septum between the left and right atria
Foramen ovale doesn’t close
Patent Ductus Arteriosus
Connection between the aorta and the pulmonary artery
Blood flows from the aorta (left side) to the pulmonary artery (right side) increasing blood flow to the lungs
Coarctation of the Aorta
- Aorta narrows, usually near the ductus arteriosus, obstructing blood flow
- Ejection click
- Systolic murmur
Persistent hypertension is common – restenosis can occur
Transposition of the Great Arteries
- Parallel circulation
- Aorta originates from the right ventricle
- Pulmonary artery originates from the left ventricle
- Prostaglandin to maintain PDA
With regards to the pathophysiology for Spina Bifida: Meningocele or Myelomeningocele, it means that what happened in the first few weeks?
In first few weeks:
Neural Tube fails to close, or
Neural Tube splits after closing
Prenatal Dx of Spina Bifida: Meningocele or Myelomeningocele
Ultrasound
Elevated AFP
Meningocele
Sac contains meninges (membranes) and CSF
No spinal cord abnormalities
Doesn’t necessarily require surgery
Myelomeningocele
Usually in lumbar area but can occur anywhere on spinal column
Impact depends on location
generally requires surgery
If Myelomeningocele is located below L2, what will the impact be?
- Partial paralysis of lower extremities
- Incontinence
If Myelomeningocele is located below S3, what will the impact be?
- No motor impairment
- May be incontinent or have some control
Pre-Op nursing interventions for Myelomeningocele surgery (5)
- Cover sac with warm NS sterile dog
- Monitor for CSF leakage
- Prone with knees slightly flexed
- Assess bowel, bladder function
- Monitor for signs of infection
Pavlik harness
dynamic splint that allows movement for Developmental Dysplasia of Hip
Amniotic Band Syndrome
occurs when the unborn baby (fetus) becomes entangled in fibrous string-like amniotic bands in the womb, restricting blood flow and affecting the baby’s development.
Osteogenesis Imperfecta
Genetic disorder - “brittle bone disease”
Autosomal dominant - affecting production of collagen, the major protein of the body’s connective tissue
Less than normal or poor collagen leads to weak bones that fracture easy
4 types of OI, mildest may not be dx all until a routine xray discloses multiple fractures
Epispadias
rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis
Hypospadias
urethra ends in an opening “under” the penis (ventral)
Phimosis - what is it and what’s treatment?
Foreskin doesn’t retract
Anomaly vs Develop. Delay
Tx with cortisone cream
Surgical intervention: Circumcision for adults
Intersex
ambiguous genitalia and/or gender chromosomes
Bladder exstrophy
protrusion of the bladder through a defect in the abdominal wall
Down syndrome Phenotype - observable signs (6)
Nuchal fold translucency Epicanthal eye folds Simian crease on palm Flat nose Wide, short neck Hypotonia
Edwards Syndrome
Trisomy 18 90% stillbirth Rare to live beyond first 1 yr Advanced maternal age Advanced paternal age
What would you expect to see on the ultrasound with a patient with Edwards Syndrome?
- Microcephaly, small jaw
- Low set ears
- Rocker feet
- Other anomalies: cleft lip/palate, cardiac, meningocele, kidney,
Patau Syndrome
Trisomy 13
90% stillbirth
Rare to live beyond first 1 yr
Multiple anomalies
What would you expect to see on the ultrasound with a patient with Patau Syndrome?
Microcephaly, sloping forehead
Low set ears
Rocker feet
Fragile X chromosome disorder
Neural development impaired due to a malfunctioning protein in the gene
Female carriers
Fragile X chromosome disorder - Phenotype - Facial Characteristics (4)
Long face
Prominent jaw
Large ears
Strabismus
What is the most common cause of intellectual disability?
Fetal Alcohol Syndrome
Phenotype (visual signs) of Fetal Alcohol Syndrome (5) – plus, infant behavior (1)
Small eye opening Flat nasal bridge Short upturned nose Smooth philtrum Thin vermilion
Infant Behavior:
Dysphagia
5 Perinatal Care Core Measures (monitors criteria and standards of care for…)
- Elective delivery
- Cesarean section
- Antenatal steroids
- Health care–associated bloodstream infections in newborns
- Exclusive breast milk feeding
Perinatal Care Core Measure: Elective Delivery – what is the standard of care and why?
Induced deliveries less than 39 weeks gestation
Why? There is a higher rate of c/s and neonatal morbidity and mortality when patients are induced when they are less than 39 weeks.
Perinatal Care Core Measure: Cesarean Section – what is the standard of care and why?
Deliveries by c/s
Why? C/S are a riskier delivery procedure with a higher rate of maternal and neonatal morbidity and mortality.
Perinatal Care Core Measure: Antenatal Steroids – what is the standard of care and why?
antenatal steroids REQUIRED for preterm laboring patients
Why? Antenatal steroids reduce the risk and incidence of premature neonatal morbidity and mortality from respiratory distress syndrome.
Perinatal Care Core Measure: Health care–associated bloodstream infections – what is the standard of care and why?
Newborns with HCA bloodstream infections
Why? High neonatal morbidity and mortality from preventable infections (handwashing, sterile technique).
Perinatal Care Core Measure: Exclusive breast milk feeding – what is the standard of care and why?
Newborns fed breast milk only from delivery
Why? The benefits to newborns from breast milk feeding are significant
Whats the most challenging Perinatal Care Core Measure?
Exclusive breast milk feeding - not a clear way to measure
Contraindications - BCP (5)
Smoking and age greater than 35 years
Moderate/severe hypertension (BP 160/100)
Undiagnosed uterine bleeding
Diabetes of more than 20 years’ duration or with vascular complications
History of embolism or thrombosis
Contraindications – subdermal, injection (5)
Breast cancer, current or previously Undiagnosed uterine bleeding Liver disease History of embolism or thrombosis Breastfeeding (Category 2) – ok after 6th wk
Side Effects - Birth control pills
Diminished menstrual flow Breast tenderness Irritability Nausea Headaches Cyclic weight gain Increased vaginal yeast infections
Adverse Effects - Birth control pills - 3
Hypertension
Myocardial infarction
Thrombophlebitis
Side Effects of subdermal, injection contraceptive
- Irregular menstruation or amenorrhea
- Acne
- Headaches
- Depression
- Weight gain
- Increased vaginal yeast infections
- Scarring or injection at insertion site (subdermal)
- Risk of decreased bone density (injection) – limit Rx to 2 yrs
- Injection required q 3 months – reminders necessary
For most people they recommend that Depo be limited to ___ years of treatment
2
ACHES effects of Oral contraceptives (combined and mini Monophasic, biphasic, triphasic, Low-dose progestin-only), Subdermal implant, injection, Vaginal contraceptive ring, Transdermal patch
- Abdominal pain – severe
- Chest pain – severe, with cough, SOB, or on deep inspiration
- Headache – severe, dizziness, numbness, esp if one side
- Eye – vision loss, blurring, speech problems
- Severe leg pain – calf or thigh
Intrauterine Device (IUD) - PAINS
- Period late
- Abdominal pain, pain with intercourse
- Infection exposure or vaginal discharge
- Not feeling well, fever, or chills
- String – missing, shorter, or longer
Pros of Intrauterine Device (IUD) - 4
No continued expense
No daily attention
No interference with intercourse
May decrease risk of endometrial CA
Contraindications/Side Effects of IUD - 3 each
Contraindications:
- Current STI
- Genital tract cancer
- Uterine anomalies, fibroids
Side Effects:
- Irregular bleeding
- Amenorrhea
- Pelvic infections
If period is late on IUD, what does that indicate?
they’ve gotten pregnant anyway
64% of women who die of heart disease have had ____
no previous symptoms
1 in 4 women die of heart disease
1 in 8 women will develop breast cancer in her lifetime = ___% chance in her lifetime
12.4 %
Benign breast disorders during teens-20s
Fibroadenoma
Benign breast disorders during 20s-50s
Fibrocystic breast changes
Benign breast disorders near/During menopause
Ductal ectasia
Intraductal papilloma
Malignant breast disorders (3)
Ductal Carcinoma in situ
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
Risk factors for malignant breast disorders
Mutation of the BRCA1 and BRCA2 genes
Mutation of CHEK-2 gene in men and women
Primary vs secondary amenorrhea
Primary – not established by age 16
Secondary – cessation of regular menses
Primary vs secondary dysmenorrhea
Primary – cramps NOS
Secondary – pathology:
- Polyps, Fibroids (Leimyomas), Cysts
- Endometriosis
- Polycystic Ovarian Syndrome
- Infections
Endometriosis
Excessive endometrial production +
Reflux of blood and tissue to fallopian tubes
symptoms:
Dysmenorrhea
Dyspareunia
Treatments for Endometriosis (3)
Oral contraceptive
Synthetic androgen
Invasive tx:
Laparotomy with laser excision
Polycystic Ovarian Syndrome
Hyperinsulinism – Increased androgen production
anovulation
Follicular ovarian cysts don’t mature
Treatment for Polycystic Ovarian Syndrome
Oral contraceptive
Metformin
Spironaldactone to decrease hair growth (antiandrogen)
Clomid for infertility
What are the barrier methods of contraception?
- Diaphragm, cervical cap
- Condoms (male and female) - Latex allergies
- Contraceptive sponge - Spermicides
Sterilization
- Female: Tubal ligation, c/s or hysteroscopic, Essure
- Male: Vasectomy
“Natural Family Planning”
Periodic Abstinence
Calendar Rhythm
Symptothermal
Periodic Abstinence
Menstrual bleeding
Cervical mucus
Basal body temperature
Symptothermal
Cervical mucus
Basal body temperature
Secondary sx -> increased libido, mittelschmerz, midcycle spotting, pelvic tenderness, vulvar fullness.
Hormonal forms of contraceptives
- Oral contraceptives – combined and mini
Monophasic, biphasic, triphasic
Low-dose progestin-only - Subdermal implant, injection
- Vaginal contraceptive ring
- Transdermal patch
Emergency Postcoital Contraception
“Morning After” pill
Plan B
Copper-releasing intrauterine device IUD
Therapeutic vs spontaneous abortion
Therapeutic Abortion = elective procedure
Spontaneous Abortion = “miscarriage” at any gestation
Copper-releasing intrauterine device IUD is ___% reliable as emergency contraception in the first few days after exposure
99
cystocele
prolapsed bladder
2 infections that are not STI
Bacterial Vaginosis – fishy-smelling white discharge
- infection stemming from decrease in normal flora
Candidiasis – cottage cheese-like white discharge
- yeast infection from a change in vaginal ph
Complication of an STI
Pelvic Inflammatory Disease – chronic inflammation from exposure to multiple microorganisms
can lead to ectopic pregnancy or infertility
Sexually Transmitted Infections
Acquired immunodeficiency syndrome
Condylomata Acuminata
(HPV and vaccine)
Chlamydia
Gonorrhea
Herpes genitalis
Syphilis
TrichomoniasisInfertility
Lack of conception after 12 mos (34 yrs and
Diagnostic testing for infertility: male
Semen analysis Endocrine P postcoital test Ultrasonography Testicular biopsy
Diagnostic testing for infertility: female
Thyroid function test Glucose tolerance test Serum prolactin levels Specific hormonal assays Ultrasonography Endometrial biopsy Hysterosalpingography Laparoscopy
Clinical Termination: Medical
Medication inducing uterine contractions (RU-486)
Can we done up to 63 days of gestation
Clinical Termination: Surgical - 3
Menstrual extraction, endometrial aspiration
- 5 to 7 weeks gestation
Vacuum aspiration
- Up to 12 weeks gestation
Dilatation and extraction (D+E)
- 2nd trimester – up to 16 weeks
Common complications of termination
excessive bleeding, cramping
Rare complications of termination
hemorrhage incomplete abortion infection Postabortal Syndrome (a form of PTSD) Asherman syndrome: uterine adhesions
Medications that are treatment options for infertility - how do they work? (5)
- Increase sperm count + motility
- Induce ovulation
- Facilitate cervical mucous formation
- Reduce antibody concentration
- Suppress endometriosis
Reproductive alternatives
- Oocyte Donation
- Embryo Donation
- Therapeutic Insemination
- Surrogate Mother (Surrogate mother’s egg, Surrogate mother’s uterus)
- Adoption
Symptoms and treatment for AIDS - is it cured?
Symptoms: asymptomatic
Treatment: antiretrovirals
Cured: No
Symptoms and treatment for Chlamydia - is it cured?
Symptoms: asymptomatic or yellowish discharge, painful urination
Treatment: Azithromycin, Coxycycline
Cured: Yes
Symptoms and treatment for Gonorrhea - is it cured?
Symptoms: purulent discharge, painful urination
Treatment: Azithromycin, Coxycycline
Cured: Yes
Symptoms and treatment for Condylomata - is it cured?
Symptoms: HPV warts
Treatment: TCA, cryotherapy
Cured: No
Symptoms and treatment for Herpes - is it cured?
Symptoms: painful vesicles
Treatment: Acyclovir
Cured: No
Symptoms and treatment for Syphillis - is it cured?
Symptoms: Lesions, sores, near issues, painless chancre
Treatment: Penicillin G
Cured: Yes
Symptoms and treatment for Trichomoniasis - is it cured?
Symptoms: discharge/pain
Treatment: metronidazole
Cured: Yes
