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PCC IV > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is included in preconception care?

A
  1. giving protection (immunizations)
  2. managing conditions
  3. avoiding harmful exposures
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2
Q

What immunizations are indicated during pregnancy? (3)

A
  1. Flu
  2. T-dap
  3. Hep B
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3
Q

What is the purpose of adequate Folic acid intake?

A

prevents neural tube defects

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4
Q

What is the indicated folic acid range?

A

400-800 mcg

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5
Q

What is the indicated range for BMI during preconception?

A

18.5-30

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6
Q

Probable pregnancy?

A

Positive pregnancy test
Braxton hicks contractions
Goodell’s sign
Hegar’s sign
Chadwick’s sign

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7
Q

What is Goodell’s sign?

A

softening of cervix

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8
Q

What is Hegar’s sign?

A

softening of the lower portion of the uterus

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9
Q

What is Chadwick’s sign?

A

slight bluing of female genitalia

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10
Q

Positive pregnancy?

A

ultrasound (see fetus)
fetal movements confirmed by provider
confirmed fetal heart tones

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11
Q

When might a provider feel fetal movements?

A

20 weeks

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12
Q

When are there fetal heart tones?

A

8-9 weeks

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13
Q

How would we calculate a woman’s estimated due date?

A

Naegele’s Rule

First day of last menstrual period
- 3 months
+ 7 days
= due date

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14
Q

When is there viability for the fetus?

A

23-25 weeks gestation

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15
Q

When does the neural tube close?

A

week 4

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16
Q

When is the heart developed?

A

week 3

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17
Q

When might a mother feel fetal movements?

A

week 13-16

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18
Q

When do fetal lungs begin to produce surfactant?

A

week 23-24

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19
Q

When are CNS developed?

A

week 3

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20
Q

When are eyes, arms, legs, ears developed?

A

week 4

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21
Q

When are teeth and palate developed?

A

week 6

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22
Q

When are external genitals developed?

A

week 7

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23
Q

What does G stand for?

A

number of pregnancies

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24
Q

What does T stand for?

A

number of pregnancies that have ended at term

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25
Q

When is full term?

A

> 37 weeks

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26
Q

What does P stand for?

A

number of pregnancies that ended preterm

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27
Q

When is preterm?

A

20-37 weeks

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28
Q

What does A stand for?

A

number of pregnancies that end by abortion

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29
Q

When is abortion?

A

before 20 weeks

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30
Q

What does L stand for?

A

number of living children

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31
Q

Role of amniotic fluid?

A

protection
regulates temp
growth

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32
Q

Role of umbilical cord?

A

perfusion

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33
Q

Role of placenta?

A

circulation
protection: immunoglobulins
endocrine: hCG

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34
Q

What birth control methods have a high risk for developing TSS?

A

Diaphragm
Contraceptive Sponges
(barrier methods)

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35
Q

S/S of TSS (7)

A

high fever
faint feeling
hypotensive
watery diarrhea
headache
macular rash
muscle aches

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36
Q

Early warning signs of medical complications for users of birth control pill?

A

A: abdominal pain
C: chest pain
H: headache
E: eye problems
S: severe leg pain

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37
Q

What testing is required to ensure proper match for organ donation?

A
  1. blood type
  2. HLA
  3. crossmatching
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38
Q

Higher percentage indicates higher risk of organ rejection?

A

Panel Reactive Antibody

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39
Q

When is Panel Reactive Antibody drawn?

A

every month when on waiting list

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40
Q

What result from crossmatching indicates the organ can be donated?

A

negative

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41
Q

What are the 2 highest risks while taking immunosupressants?

A

bleeding
infections

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42
Q

What are 2 goals after transplantation?

A

prevent rejection
prevent infection

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43
Q

When are transplant examinations performed after transplantation?

A

6 months
1 year
3 years

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44
Q

Signs of ACUTE kidney rejection?

A

pain at site of transplant
flu-like symptoms
fever
wt changes
edema
changes in HR
reduction in urine output

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45
Q

Hyperacute Rejection?

A

during surgery or up to 48hrs after

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46
Q

What is the treatment for hyperacute rejection?

A

organ must be removed

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47
Q

Treatment for acute rejection?

A

medications

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48
Q

Treatment for chronic rejection?

A

new transplant

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49
Q

How many immunosuppressants are transplant recipients usually prescribed?

A

3

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50
Q

What meds are transplant recipients prescribed?

A

immunosuppressants
calcineurin inhibitors (sandimmune)
cytotoxic meds (Cellcept, Imuran)
polyclonal antibodies (Thymoglobulin)
Corticosteriods (-sone)

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51
Q

Which kind of medications can cause fertility problems?

A

cytotoxic meds

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52
Q

What are S/E of corticosteriods (9)?

A

HTN
osteoporosis
wt gain
insomnia
blurred vision
hyperglycemia
mood changes
edema
hair growth

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53
Q

Brain death criteria?

A

hemodynamically stable
body temp >90F
pupils nonreactive to light and movement
no spontaneous reaction to physical stimuli
apnea in presence of hypercapnia

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54
Q

What level should MAP be at to adequately perfuse oxygen to organs?

A

> 65

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55
Q

How long do hearts and lungs last?

A

4-6hrs

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56
Q

How long does the liver last?

A

12hrs

57
Q

How long does the kidney last?

A

36hrs

58
Q

What are the 3 major risk of death for post-transplant recipients?

A

infections
CVD
Cancer

59
Q

MOA of the pill?

A

suppresses ovulation and thickens mucous

60
Q

Which bc method lowers risk of ovarian, endometrial, and colorectal cancers?

A

the pill

61
Q

What bc methods has the highest risk for DVT?

A

the pill
contraceptive patch

62
Q

What bc method reduces in effectiveness when taken along with antibiotics/anticonvulsants?

A

the pill

63
Q

When to start the pill?

A

first day of her next period or sunday after start of her next period

64
Q

What to do when missed a bc pill?

A

take ASAP
Continue taking the remaining pills at the usual time
May mean 2 pills on same day

65
Q

What are risk factors associated with taking the pill/patch/vaginal ring?

A

high cholesterol
MI
stroke
cervical and breast cancer

66
Q

S/E of the pill/patch/hormonal IUD/vaginal ring?

A

irregular bleeding
bloating
breast tenderness
nausea
depression
wt gain
headache

67
Q

What are two nursing considerations/assessments for the pill?

A

need pap smear and breast exam prior
exacerbates fluid retention

68
Q

MOA of contraceptive patch?

A

thickens mucous

69
Q

Teaching for contraceptive patch?

A

requires patch replacement once a week

apply patch the same day of the week for 3 weeks with no application on the 4th week

can be used in water

70
Q

Special considerations with the patch? (2)

A

avoids liver metabolism
less effective when >198lbs

71
Q

MOA of IUD?

A

releases a chemical substance that damages sperm in transit and prevents fertilization

72
Q

Education for IUD?

A

ensure placement by locating presence of small string

sign consent form

can be easily reversed and immediate return of fetility

73
Q

How long is hormonal IUD effective?

A

3-5 years

74
Q

How long is copper IUD effective?

A

10 years

75
Q

What are 2 advantages of the copper IUD?

A

no hormones

76
Q

What are risks associated with the IUD?

A

pelvic inflammatory disease
uterine perforation
ectopic pregnancy
bacterial vaginosis

77
Q

What 2 assessments are required before IUD implantation?

A

pregnancy test
pap smear

78
Q

What is the most effective barrier method?

A

diaphragm

79
Q

Education for diaphragm?

A

need prescription and to be fitted by provider

replace every 2 years and refit for 20% wt fluctuation

can be inserted up to 6 hrs before sex.
must stay in place for 6hrs after sex.
no more than 24hrs.

spermicide must be reapplied after each use

empty bladder prior to insertion

wash after each use

80
Q

When is the diaphragm contraindicated?

A

patients with
cystocele
uterine prolapse
recurrent UTIs

81
Q

MOA of spermicide?

A

causes vaginal flora to be more acidic

82
Q

Education with spermicide?

A

insert 15min before sex
only effective for 1hr
should not be removed until 6hrs after sex

83
Q

S/E of spermicide?

A

lesions
increased risk of HIV if used more than 2x daily

84
Q

MOA of vaginal ring?

A

etonogestrel and ethinyl estradiol

85
Q

education for vaginal ring?

A

replace after 3 weeks and within 7 days

insert on same day monthly

if removed for greater than 4hr, replace with a barrier method for 7 days

requires prescription

86
Q

MOA of minipill?

A

suppresses ovulation and thickens mucous

87
Q

Which bc method is great option for breastfeeding women?

A

minipill

88
Q

S/E of minipill?

A

irregular bleeding
breast tenderness
nausea
headache

89
Q

MOA of depo provera?

A

suppresses ovulation and thickens mucous

90
Q

Which bc method decreases risk of uterine cancer if long-term use?

A

depo provera

91
Q

education for depo provera?

A

inject every 11-13 weeks

inject should be within first 5 days of cycle

maintain adequate intake of calcium and vit D

regular WB exercises

only 4 inject a year

return to fertility can take up to 18 months

92
Q

S/E of depo provera?

A

decreased bone mineral density
wt gain
depression
headache
irregular spotting

93
Q

What are contraindications for depo provera?

A

breast cancer
CVD
abnormal liver function

94
Q

Which bc method can impair glucose tolerance in DM pts?

A

depo provera

95
Q

Types of natural family planning?

A

abstinence
withdrawal
calendar rhythm method
cycle beads (standard days method)
basal body temp
cervical mucus ovulation detection

96
Q

MOA of morning after pill?

A

suppresses ovulation and transport of sperm

97
Q

Education for morning after pill?

A

take within 72hrs after sex
don’t use on regular basis

98
Q

S/E of morning after pill?

A

nausea
heavy vaginal bleeding
lower abdomen pain
fatigue
headache

99
Q

BiPAP?

A

higher inspiration pressure
lower expiration pressure
acute issues or neurological

100
Q

Education for CPAP or BiPAP?

A

avoid sedatives, alcohol, substances
wt loss

101
Q

Severe OSA?

A

> 15 events per hour

102
Q

Contraindications for using CPAP or BiPAP?

A

increased secretions
trauma to face
uncooperative pt
reduced consciousness
N/V

103
Q

S/S of sleep apnea?

A

waking up frequently
snoring
insomnia
daytime sleepiness
spouse notices apnea episodes lasting at least 10sec
morning headaches
personality changes/irritable

104
Q

Diagnostics for OSA?

A

history/questionnaires (Berlin, Stop Bang)
sleep study
RDI: rest disturbance index
overnight pulse ox
sleep diary

105
Q

What is the gold standard to diagnosing OSA?

A

polysomnography (sleep study)

106
Q

What RDI score indicates OSA?

A

greater than 5 events per hour

107
Q

What surgical procedures can be completed to help with OSA?

A

UPP or UP3
Radiofrequency ablation (RFA)
Implanted neurostimulators

108
Q

Education with UPP or UP3?

A

sore throat for 6 months
no immediate changes

109
Q

Which surgical procedure for OSA is least invasive?

A

Radiofrequency ablation (RFA)

110
Q

Surgical procedures for severe/life-threatening OSA?

A

tracheostomy
bariatric surgery

111
Q

Hypoxemic partial O2?

A

<60%

112
Q

Hypercapnic partial CO2 and pH?

A

> 50% and acidic

113
Q

ARDS patho?

A

lung space filled with fluid (inflammation increases permeability)

114
Q

First phase of ARDS?

A

injury/exudative: 24-72hrs after injury

115
Q

Second phase of ARDS?

A

Reparative/proliferative: 1-2 weeks (inflammatory response)

116
Q

Third phase of ARDS?

A

Fibrotic: 2-3 weeks (lungs remodeled)

117
Q

S/S of respiratory failure (6)

A

SOB
accessory muscle use
tripod position
retractions
pursed lip breathing
paradoxical breathing

118
Q

S/S of ARDS?

A

1st sign: changes in mentation bc hypercapnia
Cardiac: tachycardic, HTN

119
Q

Interventions to promote gas exchange?

A

hydration
position changes
support cardiac output with inotropic meds

120
Q

meds commonly used for respiratory issues?

A

bronchodilators (albuterol)
corticosteroids (solumedrol)
diuretics (lasix)
antibiotics
anti-anxiety, analgesics, paralytics

121
Q

S/E of bronchodilators?

A

tachycardic
headache
N/V
anxiety
tremor
dry mouth

122
Q

S/E of diuretics?

A

dizziness
headache
low K
muscle cramps

123
Q

S/E of antibiotics?

A

gi upset
n/v

124
Q

S/E of anti-anxiety, analgesics, paralytics?

A

decreased CNS

125
Q

ART line?

A

arterial BP
MAP

126
Q

Implications for administering paralytic?

A

sedate before

127
Q

CVP?

A

Afterload (resistance)

128
Q

Pulmonary Artery Catheter?

A

preload
volume

129
Q

Function of hemodynamic monitoring?

A

better idea of fluid balance and cardiac functioning

130
Q

CO values?

A

4-8 L/min

131
Q

PAWP values?

A

preload (volume)
6-12 mmHg

132
Q

CVP values?

A

afterload (resistance)
2-9 mmHg

133
Q

SV values?

A

60-150 mL/beat

134
Q

Assessments for hemodynamic monitoring?

A

monitor insertion sites
monitor waveforms

135
Q

Complications of hemodynamic monitoring?

A

air emboli/thrombus formations
neuromuscular impairment
infection
hemorrhage
pneumothorax

136
Q

Nurse’s priority with ventilated pt?

A

patent airway
adequate oxygenation
support hemodynamic functioning?

137
Q

DOPES?

A

Displaced ET tube
Obstruction
Possible pneumothorax
Equipment
Stacking: breath stacking

138
Q

What meds are common for ventilated pts?

A

Benzodiazepine (lorazepam, versed)
General anesthesia (Propofol)
Corticosteroids (Dexamethasone)
Opioid Analgesics (Fentanyl)
Neuromuscular Blocking Agents (Rocuronium)
Antibiotics

139
Q

Interventions for ventilated pt?

A

HOB 30-35
Oral care

PCC IV (4 decks)

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