Exam 1 Flashcards
What is included in preconception care?
- giving protection (immunizations)
- managing conditions
- avoiding harmful exposures
What immunizations are indicated during pregnancy? (3)
- Flu
- T-dap
- Hep B
What is the purpose of adequate Folic acid intake?
prevents neural tube defects
What is the indicated folic acid range?
400-800 mcg
What is the indicated range for BMI during preconception?
18.5-30
Probable pregnancy?
Positive pregnancy test
Braxton hicks contractions
Goodell’s sign
Hegar’s sign
Chadwick’s sign
What is Goodell’s sign?
softening of cervix
What is Hegar’s sign?
softening of the lower portion of the uterus
What is Chadwick’s sign?
slight bluing of female genitalia
Positive pregnancy?
ultrasound (see fetus)
fetal movements confirmed by provider
confirmed fetal heart tones
When might a provider feel fetal movements?
20 weeks
When are there fetal heart tones?
8-9 weeks
How would we calculate a woman’s estimated due date?
Naegele’s Rule
First day of last menstrual period
- 3 months
+ 7 days
= due date
When is there viability for the fetus?
23-25 weeks gestation
When does the neural tube close?
week 4
When is the heart developed?
week 3
When might a mother feel fetal movements?
week 13-16
When do fetal lungs begin to produce surfactant?
week 23-24
When are CNS developed?
week 3
When are eyes, arms, legs, ears developed?
week 4
When are teeth and palate developed?
week 6
When are external genitals developed?
week 7
What does G stand for?
number of pregnancies
What does T stand for?
number of pregnancies that have ended at term
When is full term?
> 37 weeks
What does P stand for?
number of pregnancies that ended preterm
When is preterm?
20-37 weeks
What does A stand for?
number of pregnancies that end by abortion
When is abortion?
before 20 weeks
What does L stand for?
number of living children
Role of amniotic fluid?
protection
regulates temp
growth
Role of umbilical cord?
perfusion
Role of placenta?
circulation
protection: immunoglobulins
endocrine: hCG
What birth control methods have a high risk for developing TSS?
Diaphragm
Contraceptive Sponges
(barrier methods)
S/S of TSS (7)
high fever
faint feeling
hypotensive
watery diarrhea
headache
macular rash
muscle aches
Early warning signs of medical complications for users of birth control pill?
A: abdominal pain
C: chest pain
H: headache
E: eye problems
S: severe leg pain
What testing is required to ensure proper match for organ donation?
- blood type
- HLA
- crossmatching
Higher percentage indicates higher risk of organ rejection?
Panel Reactive Antibody
When is Panel Reactive Antibody drawn?
every month when on waiting list
What result from crossmatching indicates the organ can be donated?
negative
What are the 2 highest risks while taking immunosupressants?
bleeding
infections
What are 2 goals after transplantation?
prevent rejection
prevent infection
When are transplant examinations performed after transplantation?
6 months
1 year
3 years
Signs of ACUTE kidney rejection?
pain at site of transplant
flu-like symptoms
fever
wt changes
edema
changes in HR
reduction in urine output
Hyperacute Rejection?
during surgery or up to 48hrs after
What is the treatment for hyperacute rejection?
organ must be removed
Treatment for acute rejection?
medications
Treatment for chronic rejection?
new transplant
How many immunosuppressants are transplant recipients usually prescribed?
3
What meds are transplant recipients prescribed?
immunosuppressants
calcineurin inhibitors (sandimmune)
cytotoxic meds (Cellcept, Imuran)
polyclonal antibodies (Thymoglobulin)
Corticosteriods (-sone)
Which kind of medications can cause fertility problems?
cytotoxic meds
What are S/E of corticosteriods (9)?
HTN
osteoporosis
wt gain
insomnia
blurred vision
hyperglycemia
mood changes
edema
hair growth
Brain death criteria?
hemodynamically stable
body temp >90F
pupils nonreactive to light and movement
no spontaneous reaction to physical stimuli
apnea in presence of hypercapnia
What level should MAP be at to adequately perfuse oxygen to organs?
> 65
How long do hearts and lungs last?
4-6hrs
How long does the liver last?
12hrs
How long does the kidney last?
36hrs
What are the 3 major risk of death for post-transplant recipients?
infections
CVD
Cancer
MOA of the pill?
suppresses ovulation and thickens mucous
Which bc method lowers risk of ovarian, endometrial, and colorectal cancers?
the pill
What bc methods has the highest risk for DVT?
the pill
contraceptive patch
What bc method reduces in effectiveness when taken along with antibiotics/anticonvulsants?
the pill
When to start the pill?
first day of her next period or sunday after start of her next period
What to do when missed a bc pill?
take ASAP
Continue taking the remaining pills at the usual time
May mean 2 pills on same day
What are risk factors associated with taking the pill/patch/vaginal ring?
high cholesterol
MI
stroke
cervical and breast cancer
S/E of the pill/patch/hormonal IUD/vaginal ring?
irregular bleeding
bloating
breast tenderness
nausea
depression
wt gain
headache
What are two nursing considerations/assessments for the pill?
need pap smear and breast exam prior
exacerbates fluid retention
MOA of contraceptive patch?
thickens mucous
Teaching for contraceptive patch?
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
Special considerations with the patch? (2)
avoids liver metabolism
less effective when >198lbs
MOA of IUD?
releases a chemical substance that damages sperm in transit and prevents fertilization
Education for IUD?
ensure placement by locating presence of small string
sign consent form
can be easily reversed and immediate return of fetility
How long is hormonal IUD effective?
3-5 years
How long is copper IUD effective?
10 years
What are 2 advantages of the copper IUD?
no hormones
What are risks associated with the IUD?
pelvic inflammatory disease
uterine perforation
ectopic pregnancy
bacterial vaginosis
What 2 assessments are required before IUD implantation?
pregnancy test
pap smear
What is the most effective barrier method?
diaphragm
Education for diaphragm?
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
When is the diaphragm contraindicated?
patients with
cystocele
uterine prolapse
recurrent UTIs
MOA of spermicide?
causes vaginal flora to be more acidic
Education with spermicide?
insert 15min before sex
only effective for 1hr
should not be removed until 6hrs after sex
S/E of spermicide?
lesions
increased risk of HIV if used more than 2x daily
MOA of vaginal ring?
etonogestrel and ethinyl estradiol
education for vaginal ring?
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
MOA of minipill?
suppresses ovulation and thickens mucous
Which bc method is great option for breastfeeding women?
minipill
S/E of minipill?
irregular bleeding
breast tenderness
nausea
headache
MOA of depo provera?
suppresses ovulation and thickens mucous
Which bc method decreases risk of uterine cancer if long-term use?
depo provera
education for depo provera?
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
S/E of depo provera?
decreased bone mineral density
wt gain
depression
headache
irregular spotting
What are contraindications for depo provera?
breast cancer
CVD
abnormal liver function
Which bc method can impair glucose tolerance in DM pts?
depo provera
Types of natural family planning?
abstinence
withdrawal
calendar rhythm method
cycle beads (standard days method)
basal body temp
cervical mucus ovulation detection
MOA of morning after pill?
suppresses ovulation and transport of sperm
Education for morning after pill?
take within 72hrs after sex
don’t use on regular basis
S/E of morning after pill?
nausea
heavy vaginal bleeding
lower abdomen pain
fatigue
headache
BiPAP?
higher inspiration pressure
lower expiration pressure
acute issues or neurological
Education for CPAP or BiPAP?
avoid sedatives, alcohol, substances
wt loss
Severe OSA?
> 15 events per hour
Contraindications for using CPAP or BiPAP?
increased secretions
trauma to face
uncooperative pt
reduced consciousness
N/V
S/S of sleep apnea?
waking up frequently
snoring
insomnia
daytime sleepiness
spouse notices apnea episodes lasting at least 10sec
morning headaches
personality changes/irritable
Diagnostics for OSA?
history/questionnaires (Berlin, Stop Bang)
sleep study
RDI: rest disturbance index
overnight pulse ox
sleep diary
What is the gold standard to diagnosing OSA?
polysomnography (sleep study)
What RDI score indicates OSA?
greater than 5 events per hour
What surgical procedures can be completed to help with OSA?
UPP or UP3
Radiofrequency ablation (RFA)
Implanted neurostimulators
Education with UPP or UP3?
sore throat for 6 months
no immediate changes
Which surgical procedure for OSA is least invasive?
Radiofrequency ablation (RFA)
Surgical procedures for severe/life-threatening OSA?
tracheostomy
bariatric surgery
Hypoxemic partial O2?
<60%
Hypercapnic partial CO2 and pH?
> 50% and acidic
ARDS patho?
lung space filled with fluid (inflammation increases permeability)
First phase of ARDS?
injury/exudative: 24-72hrs after injury
Second phase of ARDS?
Reparative/proliferative: 1-2 weeks (inflammatory response)
Third phase of ARDS?
Fibrotic: 2-3 weeks (lungs remodeled)
S/S of respiratory failure (6)
SOB
accessory muscle use
tripod position
retractions
pursed lip breathing
paradoxical breathing
S/S of ARDS?
1st sign: changes in mentation bc hypercapnia
Cardiac: tachycardic, HTN
Interventions to promote gas exchange?
hydration
position changes
support cardiac output with inotropic meds
meds commonly used for respiratory issues?
bronchodilators (albuterol)
corticosteroids (solumedrol)
diuretics (lasix)
antibiotics
anti-anxiety, analgesics, paralytics
S/E of bronchodilators?
tachycardic
headache
N/V
anxiety
tremor
dry mouth
S/E of diuretics?
dizziness
headache
low K
muscle cramps
S/E of antibiotics?
gi upset
n/v
S/E of anti-anxiety, analgesics, paralytics?
decreased CNS
ART line?
arterial BP
MAP
Implications for administering paralytic?
sedate before
CVP?
Afterload (resistance)
Pulmonary Artery Catheter?
preload
volume
Function of hemodynamic monitoring?
better idea of fluid balance and cardiac functioning
CO values?
4-8 L/min
PAWP values?
preload (volume)
6-12 mmHg
CVP values?
afterload (resistance)
2-9 mmHg
SV values?
60-150 mL/beat
Assessments for hemodynamic monitoring?
monitor insertion sites
monitor waveforms
Complications of hemodynamic monitoring?
air emboli/thrombus formations
neuromuscular impairment
infection
hemorrhage
pneumothorax
Nurse’s priority with ventilated pt?
patent airway
adequate oxygenation
support hemodynamic functioning?
DOPES?
Displaced ET tube
Obstruction
Possible pneumothorax
Equipment
Stacking: breath stacking
What meds are common for ventilated pts?
Benzodiazepine (lorazepam, versed)
General anesthesia (Propofol)
Corticosteroids (Dexamethasone)
Opioid Analgesics (Fentanyl)
Neuromuscular Blocking Agents (Rocuronium)
Antibiotics
Interventions for ventilated pt?
HOB 30-35
Oral care
