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OB > Day 7 and 8 (for Final Exam) > Flashcards

Day 7 and 8 (for Final Exam) Flashcards

1
Q

1 cause of death during pregnancy is

A

homicide from intimate partner violence

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2
Q

Partner Violence Screening Tool

A

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?

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3
Q

Retinoblastoma

A

“Red reflex”
Malignancy of retina
Unilateral or bilateral (25%)
Autosomal dominant gene in 40% of children

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4
Q

Treatment of Retinoblastoma

A

Chemotherapy, Radiation, Laser photo-coagulation

Surgery -> enucleation

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5
Q

What maternal infections cause congenital cataracts?

A

RR - rubella (the most common cause), rubeola

HH - herpes simplex, herpes zoster

CC - chicken pox, cytomegalovirus

poliomyelitis, influenza, Epstein-Barr virus, syphilis and toxoplasmosis.

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6
Q

What’s the treatment for congenital cataracts?

A

tetracycline antibiotics

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7
Q

Whats the most common cause of congenital cataracts?

A

maternal rubella infection

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8
Q

Choanal Atresia

A

Nasal passages are blocked by bone, soft tissue
70% are unilateral
Most are not dx at delivery
If bilateral  respiratory distress

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9
Q

What is the treatment for Choanal Atresia

A

Stents are placed in nares

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10
Q

Nursing Interventions for cleft lip/palate

A 
Respiratory status
Feeding behaviors
Parent/infant interactions - bonding
Skin integrity, Oral hygiene
Prevention of Infection
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11
Q

Treatment for cleft lip/palate

A

Surgery, based on severity

Modified feeding techniques or devices

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12
Q

ESSR for feeding difficulties

A 
E = Enlarge the nipple
S = Stimulate the suck reflex
S = Swallow fluid appropriately
R = Rest when infant signals with facial expression
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13
Q

Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)

A

Esophagus and trachea do not develop as parallel tracts

Esophagus ends as either:

  • Blind pouch
  • Connected to trachea by a fistula
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14
Q

TEF and EA Clinical Manifestations

A

***Excessive salivation and drooling: frothy mucus

Apnea
Respiratory distress after eating
Abdominal distention

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15
Q

“The Three C’s” of TEF and EA

A

coughing, choking, cyanosis

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16
Q

Diagnostic testing and treatment plan for TEF and EA

A

CXR -> radio-opaque or

Pediatric surgeon: endoscopy or bronchoscopy

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17
Q

Nursing Diagnoses for 1 day old with TEF

A
  1. Ineffective Airway Clearance
  2. Risk for aspiration
  3. Impaired gas exchange
  4. FVD
  5. Interrupted family processes
  6. Deficient knowledge
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18
Q

Abdominal wall defects: Two variations of abdominal hernias

A

Omphalacele and Gastroschisis

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19
Q

Omphalacele

A

Intra-abdominal contents herniate through umbilical cord

Covered with peritoneal membrane

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20
Q

Gastroschisis

A

Abdominal organs herniate through abdominal wall

Not covered with peritoneal membrane

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21
Q

4 types of Anorectal Malformations

A

Anal stenosis - narrowing
Anal atresia - absent -> blind pouch or fistulas
Imperforate anus - blind pouch or membrane
Fistula – recto-urethra, recto-vaginal, recto…

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22
Q

Anorectal Malformations are considered ___ congenital defects

A

Common

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23
Q

Biliary Atresia - what is it, and what are the 4 things is can lead to?

A
  • Absence or constriction of common bile duct
  • Bile cannot flow from liver into duodenum
- Results in:
Cholestasis
Fibrosis
Cirrhosis
Death
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24
Q

Clinical Manifestations of Biliary Atresia

A
  • 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
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25
Q

Cystic fibrosis

A

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

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26
Q

CFTR gene:

A

Autosomal Recessive

Both parents contribute the altered gene

Each pregnancy has 25% chance of developing altered gene

Higher incidence in Caucasians and Ashkenazi Jews.

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27
Q

What may be the first sign of cystic fibrosis? That and what other initial symptoms?

A

meconium ileus

steatorrhea - bulky, frothy, foul-smelling stool

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28
Q

Prenatal Factors associated with CHD (4)

A

Maternal insulin-dependent diabetes
Maternal rubella
Maternal alcoholism
Maternal age > 40 yrs

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29
Q

Genetic Factors associated with CHD (4)

A

Chromosomal – 50% risk Down Syndrome
Sibling with heart defect
Parent with CHD
Other non-cardiac congenital anomalies

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30
Q

Diagnosing Heart Anomalies

A

ECHO

Cardiac Catheterization

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31
Q

Congenital Heart Defects associated with Increased Pulmonary Blood Flow (Acyanotic)

A

**VSD
**ASD
**PDA
AVC

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32
Q

Congenital Heart Defects associated with Obstructed Blood Flow (Acyanotic)

A

**COA

AS

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33
Q

Congenital Heart Defects associated with Decreased Pulmonary Blood Flow (Cyanotic)

A

TOF
PS
T/PA

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34
Q

Congenital Heart Defects associated with Mixed Blood Flow (Cyanotic)

A

***TGA
HLHS
TAPVR
TA

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35
Q

Ventricular Septal Defect

A

Small or large opening in septum between left and right ventricles

Left to right shunting

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36
Q

Ventricular Septal Defect clinical presentation and assessment

A

Tachypnea, dyspnea
Poor growth, reduced fluid intake
Frequent respiratory infections
Onset of Heart Failure

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37
Q

Atrial Septal Defect

A

Small or large opening in septum between the left and right atria

Foramen ovale doesn’t close

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38
Q

Patent Ductus Arteriosus

A

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

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39
Q

Coarctation of the Aorta

A
  • Aorta narrows, usually near the ductus arteriosus, obstructing blood flow
  • Ejection click
  • Systolic murmur

Persistent hypertension is common – restenosis can occur

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40
Q

Transposition of the Great Arteries

A
  • Parallel circulation
  • Aorta originates from the right ventricle
  • Pulmonary artery originates from the left ventricle
  • Prostaglandin to maintain PDA
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41
Q

With regards to the pathophysiology for Spina Bifida: Meningocele or Myelomeningocele, it means that what happened in the first few weeks?

A

In first few weeks:
Neural Tube fails to close, or
Neural Tube splits after closing

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42
Q

Prenatal Dx of Spina Bifida: Meningocele or Myelomeningocele

A

Ultrasound

Elevated AFP

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43
Q

Meningocele

A

Sac contains meninges (membranes) and CSF

No spinal cord abnormalities

Doesn’t necessarily require surgery

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44
Q

Myelomeningocele

A

Usually in lumbar area but can occur anywhere on spinal column

Impact depends on location

generally requires surgery

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45
Q

If Myelomeningocele is located below L2, what will the impact be?

A
  • Partial paralysis of lower extremities

- Incontinence

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46
Q

If Myelomeningocele is located below S3, what will the impact be?

A
  • No motor impairment

- May be incontinent or have some control

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47
Q

Pre-Op nursing interventions for Myelomeningocele surgery (5)

A
  1. Cover sac with warm NS sterile dog
  2. Monitor for CSF leakage
  3. Prone with knees slightly flexed
  4. Assess bowel, bladder function
  5. Monitor for signs of infection
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48
Q

Pavlik harness

A

dynamic splint that allows movement for Developmental Dysplasia of Hip

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49
Q

Amniotic Band Syndrome

A

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.

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50
Q

Osteogenesis Imperfecta

A

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

51
Q

Epispadias

A

rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis

52
Q

Hypospadias

A

urethra ends in an opening “under” the penis (ventral)

53
Q

Phimosis - what is it and what’s treatment?

A

Foreskin doesn’t retract
Anomaly vs Develop. Delay

Tx with cortisone cream
Surgical intervention: Circumcision for adults

54
Q

Intersex

A

ambiguous genitalia and/or gender chromosomes

55
Q

Bladder exstrophy

A

protrusion of the bladder through a defect in the abdominal wall

56
Q

Down syndrome Phenotype - observable signs (6)

A 
Nuchal fold translucency
Epicanthal eye folds
Simian crease on palm
Flat nose
Wide, short neck
Hypotonia
57
Q

Edwards Syndrome

A 
Trisomy 18
90% stillbirth
Rare to live beyond first 1 yr
Advanced maternal age
Advanced paternal age
58
Q

What would you expect to see on the ultrasound with a patient with Edwards Syndrome?

A
  • Microcephaly, small jaw
  • Low set ears
  • Rocker feet
  • Other anomalies: cleft lip/palate, cardiac, meningocele, kidney,
59
Q

Patau Syndrome

A

Trisomy 13
90% stillbirth
Rare to live beyond first 1 yr

Multiple anomalies

60
Q

What would you expect to see on the ultrasound with a patient with Patau Syndrome?

A

Microcephaly, sloping forehead
Low set ears
Rocker feet

61
Q

Fragile X chromosome disorder

A

Neural development impaired due to a malfunctioning protein in the gene

Female carriers

62
Q

Fragile X chromosome disorder - Phenotype - Facial Characteristics (4)

A

Long face
Prominent jaw
Large ears
Strabismus

63
Q

What is the most common cause of intellectual disability?

A

Fetal Alcohol Syndrome

64
Q

Phenotype (visual signs) of Fetal Alcohol Syndrome (5) – plus, infant behavior (1)

A 
Small eye opening
Flat nasal bridge
Short upturned nose
Smooth philtrum
Thin vermilion

Infant Behavior:
Dysphagia

65
Q

5 Perinatal Care Core Measures (monitors criteria and standards of care for…)

A
  1. Elective delivery
  2. Cesarean section
  3. Antenatal steroids
  4. Health care–associated bloodstream infections in newborns
  5. Exclusive breast milk feeding
66
Q

Perinatal Care Core Measure: Elective Delivery – what is the standard of care and why?

A

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.

67
Q

Perinatal Care Core Measure: Cesarean Section – what is the standard of care and why?

A

Deliveries by c/s

Why? C/S are a riskier delivery procedure with a higher rate of maternal and neonatal morbidity and mortality.

68
Q

Perinatal Care Core Measure: Antenatal Steroids – what is the standard of care and why?

A

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.

69
Q

Perinatal Care Core Measure: Health care–associated bloodstream infections – what is the standard of care and why?

A

Newborns with HCA bloodstream infections

Why? High neonatal morbidity and mortality from preventable infections (handwashing, sterile technique).

70
Q

Perinatal Care Core Measure: Exclusive breast milk feeding – what is the standard of care and why?

A

Newborns fed breast milk only from delivery

Why? The benefits to newborns from breast milk feeding are significant

71
Q

Whats the most challenging Perinatal Care Core Measure?

A

Exclusive breast milk feeding - not a clear way to measure

72
Q

Contraindications - BCP (5)

A

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

73
Q

Contraindications – subdermal, injection (5)

A 
Breast cancer, current or previously
Undiagnosed uterine bleeding
Liver disease
History of embolism or thrombosis
Breastfeeding (Category 2) – ok after 6th wk
74
Q

Side Effects - Birth control pills

A 
Diminished menstrual flow
Breast tenderness
Irritability
Nausea
Headaches
Cyclic weight gain
Increased vaginal yeast infections
75
Q

Adverse Effects - Birth control pills - 3

A

Hypertension
Myocardial infarction
Thrombophlebitis

76
Q

Side Effects of subdermal, injection contraceptive

A
  • 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
77
Q

For most people they recommend that Depo be limited to ___ years of treatment

A

2

78
Q

ACHES effects of Oral contraceptives (combined and mini Monophasic, biphasic, triphasic, Low-dose progestin-only), Subdermal implant, injection, Vaginal contraceptive ring, Transdermal patch

A
  • 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
79
Q

Intrauterine Device (IUD) - PAINS

A
  • Period late
  • Abdominal pain, pain with intercourse
  • Infection exposure or vaginal discharge
  • Not feeling well, fever, or chills
  • String – missing, shorter, or longer
80
Q

Pros of Intrauterine Device (IUD) - 4

A

No continued expense
No daily attention
No interference with intercourse
May decrease risk of endometrial CA

81
Q

Contraindications/Side Effects of IUD - 3 each

A

Contraindications:

  • Current STI
  • Genital tract cancer
  • Uterine anomalies, fibroids

Side Effects:

  • Irregular bleeding
  • Amenorrhea
  • Pelvic infections
82
Q

If period is late on IUD, what does that indicate?

A

they’ve gotten pregnant anyway

83
Q

64% of women who die of heart disease have had ____

A

no previous symptoms

1 in 4 women die of heart disease

84
Q

1 in 8 women will develop breast cancer in her lifetime = ___% chance in her lifetime

A

12.4 %

85
Q

Benign breast disorders during teens-20s

A

Fibroadenoma

86
Q

Benign breast disorders during 20s-50s

A

Fibrocystic breast changes

87
Q

Benign breast disorders near/During menopause

A

Ductal ectasia

Intraductal papilloma

88
Q

Malignant breast disorders (3)

A

Ductal Carcinoma in situ
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma

89
Q

Risk factors for malignant breast disorders

A

Mutation of the BRCA1 and BRCA2 genes

Mutation of CHEK-2 gene in men and women

90
Q

Primary vs secondary amenorrhea

A

Primary – not established by age 16

Secondary – cessation of regular menses

91
Q

Primary vs secondary dysmenorrhea

A

Primary – cramps NOS

Secondary – pathology:

  • Polyps, Fibroids (Leimyomas), Cysts
  • Endometriosis
  • Polycystic Ovarian Syndrome
  • Infections
92
Q

Endometriosis

A

Excessive endometrial production +
Reflux of blood and tissue to fallopian tubes

symptoms:
Dysmenorrhea
Dyspareunia

93
Q

Treatments for Endometriosis (3)

A

Oral contraceptive
Synthetic androgen

Invasive tx:
Laparotomy with laser excision

94
Q

Polycystic Ovarian Syndrome

A

Hyperinsulinism – Increased androgen production

95
Q

anovulation

A

Follicular ovarian cysts don’t mature

96
Q

Treatment for Polycystic Ovarian Syndrome

A

Oral contraceptive
Metformin

Spironaldactone to decrease hair growth (antiandrogen)

Clomid for infertility

97
Q

What are the barrier methods of contraception?

A
  • Diaphragm, cervical cap
  • Condoms (male and female) - Latex allergies
  • Contraceptive sponge - Spermicides

Sterilization

  • Female: Tubal ligation, c/s or hysteroscopic, Essure
  • Male: Vasectomy
98
Q

“Natural Family Planning”

A

Periodic Abstinence
Calendar Rhythm
Symptothermal

99
Q

Periodic Abstinence

A

Menstrual bleeding
Cervical mucus
Basal body temperature

100
Q

Symptothermal

A

Cervical mucus
Basal body temperature
Secondary sx -> increased libido, mittelschmerz, midcycle spotting, pelvic tenderness, vulvar fullness.

101
Q

Hormonal forms of contraceptives

A
  • Oral contraceptives – combined and mini
    Monophasic, biphasic, triphasic
    Low-dose progestin-only
  • Subdermal implant, injection
  • Vaginal contraceptive ring
  • Transdermal patch
102
Q

Emergency Postcoital Contraception

A

“Morning After” pill
Plan B

Copper-releasing intrauterine device IUD

103
Q

Therapeutic vs spontaneous abortion

A

Therapeutic Abortion = elective procedure

Spontaneous Abortion = “miscarriage” at any gestation

104
Q

Copper-releasing intrauterine device IUD is ___% reliable as emergency contraception in the first few days after exposure

A

99

105
Q

cystocele

A

prolapsed bladder

106
Q

2 infections that are not STI

A

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

107
Q

Complication of an STI

A

Pelvic Inflammatory Disease – chronic inflammation from exposure to multiple microorganisms

can lead to ectopic pregnancy or infertility

108
Q

Sexually Transmitted Infections

A 
Acquired immunodeficiency syndrome
Condylomata Acuminata
         (HPV and vaccine)
Chlamydia
Gonorrhea
Herpes genitalis
Syphilis
Trichomoniasis
109
Q

Infertility

A

Lack of conception after 12 mos (34 yrs and

110
Q

Diagnostic testing for infertility: male

A 
Semen analysis
Endocrine
P postcoital test
Ultrasonography
Testicular biopsy
111
Q

Diagnostic testing for infertility: female

A 
Thyroid function test 
Glucose tolerance test 
Serum prolactin levels  
Specific hormonal assays 
Ultrasonography
Endometrial biopsy
Hysterosalpingography 
Laparoscopy
112
Q

Clinical Termination: Medical

A

Medication inducing uterine contractions (RU-486)

Can we done up to 63 days of gestation

113
Q

Clinical Termination: Surgical - 3

A

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

114
Q

Common complications of termination

A

excessive bleeding, cramping

115
Q

Rare complications of termination

A 
hemorrhage
incomplete abortion
infection
Postabortal Syndrome (a form of PTSD)
Asherman syndrome: uterine adhesions
116
Q

Medications that are treatment options for infertility - how do they work? (5)

A
  • Increase sperm count + motility
  • Induce ovulation
  • Facilitate cervical mucous formation
  • Reduce antibody concentration
  • Suppress endometriosis
117
Q

Reproductive alternatives

A
  • Oocyte Donation
  • Embryo Donation
  • Therapeutic Insemination
  • Surrogate Mother (Surrogate mother’s egg, Surrogate mother’s uterus)
  • Adoption
118
Q

Symptoms and treatment for AIDS - is it cured?

A

Symptoms: asymptomatic

Treatment: antiretrovirals

Cured: No

119
Q

Symptoms and treatment for Chlamydia - is it cured?

A

Symptoms: asymptomatic or yellowish discharge, painful urination

Treatment: Azithromycin, Coxycycline

Cured: Yes

120
Q

Symptoms and treatment for Gonorrhea - is it cured?

A

Symptoms: purulent discharge, painful urination

Treatment: Azithromycin, Coxycycline

Cured: Yes

121
Q

Symptoms and treatment for Condylomata - is it cured?

A

Symptoms: HPV warts

Treatment: TCA, cryotherapy

Cured: No

122
Q

Symptoms and treatment for Herpes - is it cured?

A

Symptoms: painful vesicles

Treatment: Acyclovir

Cured: No

123
Q

Symptoms and treatment for Syphillis - is it cured?

A

Symptoms: Lesions, sores, near issues, painless chancre

Treatment: Penicillin G

Cured: Yes

124
Q

Symptoms and treatment for Trichomoniasis - is it cured?

A

Symptoms: discharge/pain

Treatment: metronidazole

Cured: Yes

OB (7 decks)

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