Exam 2 Flashcards
what are the 5 factors that affect the process of labor and birth?
Passageway
Passenger
Passage and passenger relationship
Physiological forces of labor
Psychologic response
what is the favorable shapes of the pevic inlet during birth?
Gynecoid and Anthropoid
what are the unfavorable shapes of the pelvic inlet during birth?
Android and Plataploid
what are fontanelles?
intersections of cranial sutures
what is the posterior fontanelle?
back of head, forms a triangle, and closes in 8-12 weeks
what is the anterior fontanelle?
front of head, forms a diamond, and closes by 18 mon
what can closed sutures with no fontanelle cause?
Skull fractures
what is a fetal lie?
relation of the fetal spine to maternal spine
what is a longitudal fetal lie?
fetus is vertical
what is a transverse fetal lie?
fetus is perpendicular to maternal spine (right angle, laying from side to side)
what is attitude?
relation of fetal parts to one another
-flexion is normal
what is presentation r/t the fetus/passenger?
the part of the fetus that enters the pelvis first and leads through the birth canal
what is a cephalic presentation?
fetal head is presenting
what is a breech presentation?
buttock or feet is presenting
what is a shoulder presentation?
acromium process of scapula is presenting
which presentation is the only one who can result in a natural birth?
Cephalic
- vertex presentation is normal and most common
what is engagement?
when largest transverse diameter of fetus has passed through pelvic inlet
“0 station”
when does engagment occur in a primigravida mother?
before labor
when does engagement occur in a multipara?
not until labor is established
what is the station?
location of the fetus in relation to an imaginary line btwn maternal ischial spines
what are the number ranges of a station?
-5 is high towards belly button
0 is in middle of ishical spines
5 is at bottom of ischial spines ready to be birthed
what is a primary power?
involuntary uterine contractions
what is a secondary power?
mothers bearing down efforts
what is a hypertonic uterus and what can it cause?
uterus does not relax between contractions
- can cause fetal distress
what does progesterone do for the labor process?
relaxes smooth muscle
what does estrogen do for the process of labor?
stimulates uterine contractions
what are the possible causes of labor onset?
Progesterone withdraw hypothesis
Prostoglandin hypothesis
Corticotropic releasing hormone hypothesis
what is the progesterone withdraw hypothesis?
at the end of term progesterone decreases which makes estrogen stimulate contractions
what is the prostoglandin hypothesis?
inducing of labor after vaginal application of prostaglandins (semen)
what is the corticotropin releasing hormone hypothesis?
CRH increases at end of term which stimulates prostaglandins
what is lightning and what does it cause?
baby drops which causes return of urinary frequency
what is a bloody show and what can you expect ?
mucous plug is expelled causing pink secretions
labor in 24-48 hours
if mom has a rupture of membranes, what do you assess?
COAT color odor amount time
what can you use to differentiate amniotic fluid with urine?
Nitrozen paper (amniotic fluid is alkaline and urine is acidic)
what is the most accurate way to differentitate amniotic fluid and urine after a ROM?
microscope test
- fernning pattern is amniotic fluid
if a mom’s membrnaes have been ruptured for 24 hours and the baby hasnt been birthed, what do you give?
prophalactic ATB to prevent infection
when does stage 1 of labor begin and end?
begins at onset of true labor and contractions
ends when cervix is completely dialated and effaced
when does stage 2 of labor begin and end?
begins when cervix is fully dialated/effaced
ends with birth of baby
when does stage 3 of labor begin and end?
begins with birth of baby
ends when placenta is delivered
when does stage 4 of labor begin and end?
begins after placenta delivery
last for 2 hours
immediate recovery period
what is a mother and babys job during stage 1 of labor?
mother dialate baby rotate
what is the cervical dialations for the 3 phases of stage 1 of labor?
Latent: 0-3cm
Active: 4-7cm
Transition: 8-10cm
when does nursing care begin for the 1st stage of labor?
when mom reports:
- progressive, regular contractions that increase in frequency, strength, and duration
- blood tinged mucoid discharge
- fluid discharge
what are the laboring characteristics for the latent/early stage during stage 1 of labor?
last 6-8 hours
contractions can be 5-30min apart lasting 30-40 dec (mild/moderate)
station is -2 to 0
mom is excited and thoughts are centered towards baby
what are the laboring characteristics of the active phase during stage 1 of labor?
last 3-6 hours
contractions can be 2-5 min apart and last for 40-60 seconds (moderate/strong)
station is 1 to 2
mom becomes more seriou, apprehensive, and irritable
what are the laboring characterisics of the transition phase during stage 1 of labor?
last 20-40 min
contractions will be 1-2 min apart and last 60-90 seconds (very strong)
station is 2 to 3
mom is fearfull of loss of control and extremely agitated and may feel like she has to poop
what are the 7 cardinal movements?
- descent
- flexion
- internal rotation
- extension
- resitution
- external rotation
- expulsion
what side of the placenta is grey?
fetal side
what can happen to mom in the 4th stage of labor?
shaking chills or hypotonic bladder (unable to urinate)
what can make a pregancy high risk?
abnormal presentation
multiple gestation
meconium staining
PROM
abruptio placenta
Placenta previa
what is an amniotomy?
artifical rupture of membranes (AROM) to induce labor
what are the characteristics of amnitic fluid?
pale, straw colored
white flecks of vernix, lanugo and hair
no strong odor
alkaline
what can happen when membranes rupture and what do you assess?
umbillical cord could prolaspe
assess FHR and pattern immediatly
what are the 2 types of external monitoring?
Transducers for FHR
Tocodynometer for UC
what are 2 types of internal monitoring?
Spiral Electrode
B.O.W. rupture
what can cause FHR changes?
periodic changes with UC
Episodic (non-periodic) changes are not associated with UC
accelerations
decelerations
what can cause fetal tachycardia?
early fetal hypoxia
maternal fever, dehydration, or hyperthyroidism
fetal anemia
what can cause fetal bradycardia?
late fetal hypoxia
maternal hypotension or hypothermia
umbillical cord compression
fetal arrythmia
uterine hyperstimulation or rupture
abruptio placenta
what is the single best indicator of fetal well being?
FHR variability
what is an absent FHR variability?
undetected
what is a minimal FHR variablity?
greater than undetected but less than or equal to 5bpm
what is a moderate FHR variability?
6-25 bpm
what is a marked FHR varability?
greater than 25 bpm
what is reassuring FHR patterns?
FHR 110-160
moderate variabliity
accelerations with UC
what is an early deceleration r/t FHR?
baby is okay
- head could be compressed during a UC
what is a late deceleration r/t FHR?
baby bad
-decreased blood and o2
-placental insuffencicy
what is a variable deceleration r/t FHR?
baby bad
- decreased blood and 02
-cord compression
what is the nursing care managment for late or variable deceleration FHR patterns?
notify HCP immediatly
stop oxytocin
change maternal position
increase IV fluids
administer 02
prepare for delivery
what are the FHR patterns and their causes?
VEAL and CHOP
Variable to cord compression
Early to head
Acceleration to okay
Late to placental insufficency
when should a pregnant women reprt to a birthing unit?
if her membranes have ruptured
regular frequent contractions
vaginal bleeding
decreased fetal movements
what are considered regular frequent contractions for a nullipara?
5 min apart for 1 hour
what are considered regular frequent contractions for a multipara?
6-8 min apart for 1 hour
why is a urine sample taken on admission and what can it indicate?
to assess for proteinuria
-can indicate preclampsia
if mom is excessivly bleeding, what assessment do you NOT do?
Cervical examination
-notify HCP
what are the nursing actions (Vitals) during the latent phase of stage 1?
Maternal BP and RR every hour
Maternal temp every 4 hour unless over 99.6 or membranes have ruptures then every hour and if contractions have started then every 30 min
FHR every 30-15 min
what are the nursing actions (vitals) during the active phase of stage 1?
Maternal BP, RR, and HR every hour
Palpate contractions every 15-30 min
FHR every 30-15 min
what are the nursing actions (vitals) during the transition phase of stage 1?
Maternal BP, RR, and HR every 30min
Palpate contractions every 15 min
FHR every 30-15 min
what are the nursing actions (vitals) during stage 2?
Maternal BP, RR, and HR every 5-15 min
Maternal temp every 2 hour
Palpate contractions continuously
FHR evert 15-5 min
what are the nursing actions (vitals) during stage 3 of labor?
Maternal BP, RR, and HR every 5 min
Palpate contractions intermittenly to assess for placental seperation
Fetal newborn assessment, gestational age, and neurological assessment within 1st hour
APGAR at 1 and 5 min
Assesss umbillical cord for 3 vessells
what are the nursing actions (vitals) during stage 4 of labor?
Maternal BP, RR, HR, and temp every 15 min for first hour
Maternal assessment of fundus, lochia, perineum, laceration, bladder and rectum every 15 min
Fetal assessment needs to be complete in 1-4 hours post birth
After inital 8 hours, do vitals and assessment every 8 hours
Fetal skin assessed every 4 hours
what are the nursing responsibilities during stage 1 of labor?
determine true/false labor
establish rapport
orient family
position changes
provide ice chips
assist to void every 1-2 hours
rest between contractions
breathing techniques
keep couple informed
what are the nursing responsibilities during stage 2 of labor?
assist with pushing efforts
provide support
patient advocate
what are the nursing responsibilities during stages 3 and 4 of labor?
Inital care of newborn (APGAR, care of umbillical cord, physical assessment, and newborn identification)
Delivery of placenta
Enchancing attatchment
Maternal stabilization
what is a 1st degree laceration?
ectends through skin and structures superficial to muscles
what is a 2nd degree laceration?
extends through muscles of perinuem
what is a 3rd degree laceration?
extends through anal sphincter
what is a 4th degree laceration?
extends through anterior rectal wall
why are episiotomies not often performed?
bc they increase risk for a 4th degree laceration
how can you prevent a laceration?
Use counter pressure
Lubricate periunuem
use warm compress
what are the nonpharmalogical managements of discomfort while in labor?
guided imagery, massage, position changing, and effleurage
what is effleurage?
gently use the tip of funger ti touch or massage abdomen
what pharmalogical management us used for emergency c sections?
general anesthsia
what are the systemic analgesia medications used for discomfort in labor?
Opiod agonist (Demerol, Morphine)
Opiod agonist-antagonist (Nubain) *narcotic
Opiod antagonist (Ultram) *narcotic
Ataractics (Xanax)
what is Nalbuphine Hydrochlorids (Nubian) and its advantages?
It is comparable to Morphine
-works within 5 min
-minimal nausea and fetal effects
What can Nubian cause?
Drowsiness
what is Dutorphanol Tartrate (Stadol) and its advantages?
It is a narcotic and sedative
-works within 5 mun
-minimal nausea and fetal effects
what stage of labor is Stadol given?
first stage
what can Stadol cause?
Maternal hypotension, drowsiness, and dizziness
what can nerve block anesthsias cause?
Maternal hypotension
Ineffective breathing
Medication reactions
Spinal HA
What do you use for a spinal HA?
use a blood patch
what is a pudendal block?
injection into perineum
what is a pudendal block used for and what stages is it given in?
repair episiotomies
-stages 2 and 3
when is an epidural given?
when active labor begins
when is an epidural block used and what is it used for?
all stages of active labor and for the repair of episiotomies
what are the characteristics of an epidural block?
they dont wear off
gravity activated so change maternal positions if it is not effective on one side
administered continuously VIA pump
what can an epidural cause?
Longterm back pain
maternal hypotension
delay of bladder function
what can a hypotonic bladder increase the risk for?
postpartum hemmorage
*so make sure momma is urinating
what are the contradictions of an epidural?
Infection
Blood coagulation *monitor platelets
Increase ICP
Allergies
Hypovolemic shock
what type of anesthsia is used in C-section deliveries?
spinal block
what is a low spinal block?
Used in csection dele=iveries to numb nipple to feet
what can a spinal block cause?
delayed bladder control for 8-12 hours
what do you administer before an epidural and what do you do?
IV fluid blous 500-1000ml
*make sure momma empty bladder before epidural is given
what is given for hypotension during labor?
Ephedrine
how often should blood pressure be checked after administration of an epidural?
every 3-5 min for the 1st 30 min
when is the newborn period?
birth to 28 days
what is the neonatal transition?
1st few hours of life when newborn stabalixes respiratory and circulatory functions
what is surfactant required for and when does it peak?
it is required for lung expansion and peaks at 35 weeks gestation
what is the rate of breaths for a newborn?
shallow and iregular
30-60 BPM
short periods of apnea (no more than 20 seconds)
what type of breathers are newborns and what is the main nursing action?
obligatory nasal breathers
* make sure nasal passages are clear
Is acrocyanosis normal for a newborn?
yes, but only for the 1st 24 hours
what happens to the cardiovascular system of a newborn after birth?
their 1st breath inflates the lungs and decreased pulmonary vascular resistance to the pulmonary blood flow
increased pulmonary blood flow returns to left side of heart and increases pressure in left atrium
3 shunts close and chnage to maternal circulation
what does a newborns blood contain and what happens to it?
fetal hemoglobin
-will decreaase by 55% in 5 weeks
-will reduce to 5% by week 20
what is most critical to a newborns survival?
- respiration
- circulation
- heat regulation
what is convection heat loss?
loss of heat from warm body to cool air currents
what is radiation heat loss?
baby loses heat when heat transfers from warm body surface to cooler objects not in direct contact with body
what is evaporation heat loss?
baby loses heat when water is converted to vapor
- immediatly after birth when wet with amniotic fluid
what is conduction heat loss?
baby loses heat to a a cooler surface by direct contact with body
- chilled hands, cold tables, cold stethascopes
what is physiological jaundice also known as?
hyperbilirubinemia
what is physiological jaundice or hyperbilirubinemia?
inmatture liver is not able to get rid of all billirubin produced by breakdown of RBC
so billirubin seeps out of blood into skin coloring them yellow the 1st three days of life
when do signs of psychological jaundice appear?
24 hour after birth
if signs of psychological jaundice appear before 24 hours what does it mean?
something could be wrong the liver
what can decrease billirubin levels?
frequent feedings, maintain tempreture of 97.8 and monitor stool for excretion of billi
what is the normal fetal billirubin level?
less than 3
what are the nutritional needs of a newborn for the first three months?
110/115 kcal/kg/day
how much nutrition does breastmilk provide?
67 kcal/100ml
what are the changes in output requirements for a newborn that indicate a change in nutritional needs?
less than 6-8 wet diapers per day AND OR less than 3 stools every 24 hours
what is the urine output of a newborn at birth and days 1 and 2?
small quanity (40ml) is present at birth in newborns bladdar
Day 1-2: 2-6 diapers a day
what indicates adequate fluid intake?
6-8 voids a day of pale straw colored urine
what is meconium?
newborns first BM
black, tarry, and sticky
when should a baby show meconium?
within 12 hours of birth
what are the characteristics of a newborns immune system?
for the first 3 mon the baby has some immunity from mom
*if breastfed they will recieve immunity from colostrum and breastmilk
what is mongolian spot?
Bruise like spot /appearance
if a baby has a magolian spot what does the nurse do?
document well due to appearance could be mistaken for abbuse
how long should vernix caseosa be kept on baby?
1st 4-6 hours
what do increased estrogen levels cause on a newborn?
swelling of breast tissue
vaginal discharge (pseudomenstruation)
witchs milk: thin discharge from nipple
what is an ortolani test?
assessment of developmental dysplasia of the hips
* newborn girls
what is the palmar grasps?
when you touch babies palm and they grasps tightly
what is a moro reflex?
baby is startled by loud noise so they extend arms and legs and then pull tightly back to body
what is the stepping reflex?
infant is held uprught with feet touching ground and baby moves feet
what is the babinski reflex?
when you stroke the babies sole of foot and they fan out toes and turn foot inward
what is the rooting reflex?
when you stroke the side of babies cheek and baby turns toward source, opens mouth and suck
by the 5th day, what can a newborn do?
recognize mothers smell and distinguish breast milk of other lactating moms
when must the gestational age be established?
within 1st 4 hours after birth
what is an accurate newborn weight?
10-90th percentile 5.5-9 pounds
for the first 6 months what does a babies weight do?
increase by 7oz weekly and grow 2.5 cm monthly
if a mom has had alot of IV fluids during labor, what will happen?
baby will be larger but lose more weight after birth due to fluid shifts
what is the approximate head circumference of a newborn?
2cm larger than their chest circumference
what helps gaurd against heat loss?
a flexed position
what is cold stress considered?
an emergency
if no heat conservation measures are started, what happen to body tempreture?
decrease 0.2 pper min
how often is tempreture monitored on a newborn?
every 30 min until stable for 2 hours
when should a babies tempreture stabalize?
within 8-12 hours after birth
what is mottling?
lacy pattern of dialated blood vessells under skin
-results from circulation flucuations
what is harlequins sign?
deep red color develops on one side of body, while other side remains pale
- results from vasomotor disturbance in vessells
what is erythema toxicum?
eruption of lesions in area surrounding a hair follicule that are firm and consist white/yellow papules with a red base
- not on palms or feet
what is milia?
exposed sebaceous glands
-raised white spots on face or nose
what is a telangiectatic nevi birthmark?
stork bite
pale pink or red spots on eyelid, nose, lower occipital bone and neck
what are mongolian spots?
macular, bluish/black pigmentation on dorsal area or buttock
what is a nevus flammeus birthmark?
port wine stain
capillary angioma below epidermis
doesnt grow, fade or blanch
what can nevus flammeus birthmark indicate?
sturge weber syndrome
what is a nevus vasculous birthmark?
strawberry mark
capillary hemangioma, dermal and subdermal
shirinks and resolves around 6 mon
what is a diamond shaped anterior fontaneals location, time, and what can it do?
located at juncture of frontal and parietal bone
closes within 18 mon
may swell with crying, pooping and pulses with heartbeat
what is a posteriors fontanelle shape, location and time?
small and triangular
formed by parietal and occipital bone closes within 8-12 weeks
what is a cephalohematoma?
collection of blood from ruptured vessells between surface and cranial bone
does not cross the suture line
disappears 2 weeks-3mon
what can a cephalohematoma cause and what should you check?
increases risk of jaundice
check billi levels
what is a caput succedaneum?
localized soft area on scalp from long labor or vaccum extraction
fluid in caput is reestablished in 12 hr to a few days
crosses suture line
when is eye color established?
3 mon but can change for up to a year
why are newborn cries tearless?
lacrimal structures are immature
what are the airway clearance guidlines for a newborn?
suction mouth first then nose
compress bulb before inserting
insert on one side of mouth not the middle
what is the optimal tempreture range for a newborn?
97.5-99
what can hypothermia lead to in a newborn and what is it used to prevent it?
Metabolic acidosis, hypoxia, and shock
-use radiant warmer during procedures
what are signs of newborn distress?
increased RR
sternal retractions
nasal flaring
grunting
excess mucous
facial grimace
cyanosis
abdominal distention
vomiting bile
abscense of meconium and urine within 24 hours
jitteriness
glucose less than 40
what is the process of cord care of a newborn?
AWHONN clean with sterile water and let air dry
why is alcohol not used in cord care of a newborn?
can cause prolonged cord drying and seperation
how often should circumcision care be assessed in a newborn?
hourly for the 1st 4-6 hours
-no bleeding and baby is voiding regulary
if yellow exudate is formed around circumcision what do you do?
do not remove it bc it is part of the healing process
what can be given to a newborn after a circumcision?
acetaminophen every 4 hour for 24 hours
-petrolleum jelly, A&D, Destin
what happens to babies glucose after birth?
will decrease and stabalize at 50-60 during 1st several hours
if a baby is born very large or from a diabetic mom what will need to be assessed?
glucose checks more frequently
warm heel first
what needs to be made before discharge?
pediatrician follow up appt
what is the milk production anatomy?
milk is synthesized in alveoli
during pregancy estrogen and progesterone increase which stimulates breast duct proliferation and develop alveoli and increase prolactin
once placenta is expelled, progesterone levels decrease which trigger milk production
if stimulation is not occuring by 3-4 days prolactin will drop
what can trigger or increase milk production?
prolactin
-stretching nipple and compression of areola trigger the release of oxytocin
what are the stages of human milk and what do they do?
- colostrum: helps excrete billi
- transition milk: day 3-5
- mature milk: 2 week postpartum (white and blue tinged)
breastfed infants have a less likely chance of developing what longterm disorders?
Diabetes
lymphoma
leukemia
Hodgkins
Obeisty
Hypercholesterolemia
asthma
breastfed infants have a less likely chance of developing what shorterm disorders?
URI
UTI
otitis media
bacterial meningitis
allergies
what does IgA have?
antiviral and antibacterial properties
what are the complications of breastfeeding?
smoking will decrease milk production
do not breastfeed if baby has galactosemia
what are the hunger cues for breastfeeding moms?
Early: licking lips, excess moving, putting hands in mouth
Late: crying
what is powdered formula?
Least expensive
not sterile
requires careful handeling to avoid contamination
what is formula concentrate?
Expensive
must be diluted with equal part water that has been boiled
what is ready to feed formula?
Most expensive
no mixing, and is sterile
given to immunocompromised babies
how long should a baby be in a rear facing carseat?
2 years
what kind of clothing should a baby wear in a carseat?
no heavy clothing
when are newborn screenings given?
24-48 hours old
when they are feeding enough to metabolise
what is peurperium?
interval between birth and return of reproductive organs to normal state
what is involution?
return of uterus to a non-pregnant state
what are the times of involution of uterus?
Immediatly: fundus is at midline 2cm above umbillicus
12hr: level umbillicus
24hr: 1 cm below umbillicus and it decreases 1-2cm every 24 hours
6 days: halfway btwn symphysis pubis and umbillicus
2 weeks: uterus is a pelvic organ again
6 weeks: returns to non preganant state
what can slow uterine involution?
prolonged labor: muscles relax
Anesthsia: muscle relaxation results in boggy uterus
Difficult birth: uterus is manipulated causing muscle fatigue
Multipara: repeated distention leads to uterus stretching and decreased tone
Full bladder: uterus is pushed up, pressure interferes with effective contractions
Incomplete expulsion of placenta: tissue interferes with ability of uterus to remain contracted
Infection: inflammation decreases muscle ability to contract
Overdistention of uterus:
what is lochia?
post birth uterine discharge
what is lochia rubra?
blood and uterine debris (1-3 days)
red and dark red
what is lochia serosa?
Old blood, serum, leukocytes and tissue debries (4-10days)
pink and brown
what is lochia alba?
Leukocytes, mucus, serum, bacteria, and tissue debris (11day-4 weeks)
yellow and white
what is a nursing action for lochia flow estimation?
how long the peripad has been in place
what are the classifications of lochia?
Scant: less than 1 in
Light: less than 4 in
Moderate: less than 6 in
Heavy: saturation witin 1 hr of pad application
how long does it take for menstruation to return postpartum?
7-12 weeks in nonlactating mom
3mon-3 year in lactating mom
what do you assess with episiotomies and when do they heal?
REEDA and in 2-3 weeks
when do hemmroids heal postpartum?
within 6 weeks
what does colostrum do r/t changes postpartum?
helps binding of billi and has laxative effect to help pass meconium
when does engorgment occur and what can it cause?
day 3-4
breast may be swollen, firm, tender and warm to touch
- use warm compress or ICE, dont over pump or stimulate and wear a sports bra
what happens to prolocatin levels when not nursing?
drop rapidly
what happens within 12 hours post birth r/t bladder of mom?
profuse diaphoresis due to decrease estrogen
what hormones rapidly decrease after expulsion of placenta?
estrogen, preogesterone, prolactin, cortisol, and insulin
what is the postpartum chill and when should it be a concern?
intense tremors/shivering after birth
-if not followed with a fever it is not a concern
what happens to the cardiovascular system after birth and what should you assess?
increasing clotting factors anf risk for thromboembolism
assess Holmans sign and encourage ambulation
increased blood volume is eliminated with 1st 2 weeks
what happens due to increased blood volume loss?
hypervolemia allows mom to tolerate blood loss
vaginal: 500ml
c-section: 1000ml
when is baby blues and what can worsen them?
1st week and disappear by day 10
-symptoms worsen by sleep deprivation
if baby blues extends past 10 days what could it be?
postpartum depression
what immunizations are given to mom before discharge?
Rubello
RHOgam within 72 hours after birth
TDAPP to decrease pertiussis
when can sexual intercourse return after birth?
2-4 weeks
-when bleeding has stopped and perineum has healed
what is a BUBBLE-HE examination?
Breast
uterus
bladdar
bowel
laceration
episotomies
Hemmroids
emotions
What is increment?
building up of contractions
what is acme?
peak of contraction
what is decrement?
letting up of contraction
what is polycystic ovarian syndrome (PCOS)?
complex endocrine disorder of ovarian dysfunction
what are common signs of PCOS?
Menstrual dysfunction
hyperandrogenism
obeisity
hyperinsulinemia
Infertility
what is the most common cause of infertility?
PCOS
what are the signs of high androgens?
deepened voice
increase hair growth
oily skin
ammenorhea and decreased breast size
what do you need to do to diagnose PCOS?
rule out other endocrine disorders
4fold: hx, physical, labs, and imaging
what does PCOS increase the risk for?
type 2 diabetes
HTN
cardiovascular disease
endometrial, breast, and ovarian cancer
what is the treatment of PCOS?
oral contraceptions
antiandrogens
treat symptoms
what is toxic shock syndrome (TSS)?
a disease of women that occur at or near menses or during postpartum period
what are the signs of TSS?
high fever, hypotension, rash on truck, palms and soles, and multisystem involvement
what can increase the risk for TSS?
keeping a tampon in for a long time, diaphragm and cervical caps
what do lab levels look like with TSS?
Increased BUN and creatnine
increased liver enzymes
decreased platelets
what is the causative organism of TSS?
Staph *it is preventable
what is syphilis?
bacterial STI
what is syphilis spread by?
vagina, anal, and oral
vaginal canal during birth and can cross placenta to infect baby in utero
what are the early signs of syphilis?
Painless chancre sore, low grade fever, wt loss and malaise
what are the late signs of syphilis?
6week-6mon
skin eruptions, rash on hands and feet, enlarged liver and spleen and chronic sore throat/hoarsness
what is the treament of syphilis?
single injection of penecillin
what can syphilis cause if left untreated?
blindness, insanity, paralysis, and death
preterm labor and still births
what is Gonorrhea?
Bacterial STI
what is Gonorrhea spread by?
Vaginal, anal and oral
In utero and vaginal canal during birth
what are the signs of Gonnorhea?
yellow/grey/green discharge heavy menstruation, abdominal cramps and burning urination in women
swollen and painful testicals in men
what is the treatment of Gonorrhea?
Cefixime or Ceftriaxone (Cephalosporin)
prophylactic eye tx in newborns
why do you need to be aware of Cureal for the treatment of Gonorrhea?
it has ATB resistant strains of gonorrhea
what is chlamydia?
bacterial STI and most common in US
what is chlamydia spread by?
Vaginal, anal and oral
vaginal canal during birth
what are the symptoms of chlamydia?
Many people have no symptoms
watery white discharge, burning on urination, abdominal pain, and swollen testicles
what is the treatment of chlamydia?
single dose of azithromycin or 1 week of doxycline (BID)
what is human pailloma virus (HPV)?
Viral STI
what is HPV spread by?
vagina, anal and oral
what are the signs of HPV?
Genital warts
what is the treatment for HPV?
No cure but a healthy immune system can fight it off naturally
what helps to protect against HPV?
Gardasil
what can HPV cause in men?
throat cancer
what can HPV cause in women?
cervical cancer
what is Herpes simplex virus (HSV)?
Viral STI
what is HSV spread by?
vaginal anal oral
vaginal canal during birth
what is HSV1?
oral, cold sores
what is HSV2?
genital
what is HSV3?
chicken pox and shingles
what birth is given to prevent spread of HSV to baby?
c section, bc neonatal herpes (congenital) increases risk of death
what is the treatment for HSV?
No cure but antivirals can shorten or prevent outbreaks
Valtrex and Acvclovir
what is human immunodeficency virus (HIV)?
viral STD found in blood semen vaginal fluid and breastmilk
what is HIV spread by?
Vaginal. anal, and oral
blood
baby in utero d/t crossing placenta
what can HIV cause?
Acquired Immune defienceny (AIDS)
*no visible signs of infection
what is the treatment of HIV?
No cure but antivirals are given (Zidovudine)
Csection delivery
formula feed
what is Hepatitis B (HBV)?
Viral STI
inflammation of liver and most common hepatitis
what is hepatitis A?
oral fecal route
what is hepatitis C?
blood route
what is the treatment of HBV?
No cure but can prevent it by taking the Hep B vaccine
what is the Hep B vaccine?
3 injections and requires consent
what is trichomoniasis?
Parasitic STI
most common curable STI
what is the threat of trich?
it increases womens vulnerability for HIV bc it thins the lining of vagina so other diseases are easier to get in
what are the symptoms of trich?
Vaginal itching, forthy green/yellow discharge with a fishy odor
what is the treatment of trich?
Metronidazole (flagyl)
what do you need to avoid when taking flaglyl and what can it cause?
alchol can cause tremors and abd pain
what can trich cause in pregncancy?
Premature birth and low birth weight babies
what is trich linked to?
pelvic inflammatory disease
what is bacterial vaginosis caused from?
imbalence in good and bad bacteria in vagina
what are the signs of bacterial vaginosis?
fishy smell with thin/white/milkly discharge
what can BV increase the risk for in pregnant women?
prematurity or LBW
what is BV also known as and what is used to treat it?
vulvo vaginal candidas and Flaglyl
what is subfertility?
when both parents have decreased fertitliy
what is needed for a fertile female reproductive system?
cervical musous
patent fallopian tubes
functional hypothalamic pituitary
ovaries are able to release ova in a regular cycle
endometrium must be able to prepare for implantation
adequate reproductive hormones
what can an ectopic pregnancy cause?
scarring in fallopian tubes which can cause infertiltiy
what is the diagnostic test for tubal patency and uterine structer due to an ectopic pregnancy?
Hysterosalpingography
what can increase the risk of infertitlity in men?
Pesticide exposure and smoking can decrease sperm
what does the serum lab show for infertility?
Progesterone greater than 3 means ovulation is happening
Progesterone less than 3 means no ovulation which could be a problem with infertiltiy
what test needs to be done if there is a lack of ovarian function?
basal body tempreture, hormone assessment, endometrial biopsy, and transvaginal ultrasound
what test needs to be done if cervical problems are suspected?
the capacity of cervical mucous
what test needs to be done if tubal or uterine problems are suspected?
Hysterosalpingography, hysteroscopy, and a laparscopy
what test needs to be done if male infertility is suspected?
Semen analysis and screen for antisemen antibodies
when is pharacologic intervention take place for infertiltity?
if there is an abnormal ovarian or endometrial function
what is assessed when looking at cervical mucous?
if mucous is watery it means that ovulation is occuring bc it allows the cervix to become elastic so that sperm can pass through
if semen and ovary analysis are normal, what med is given for fertility?
Clomid
what does CLomid do?
induces ovulation, which can increase the risk of multiple babies
what are the side effects of Clomid?
visual disturbances and hormonal flucuations
what are the indications for vitro fertilization (IVF)?
infertility from tubal factors
mucous abnormalities
male infertility
female immunologic infertility
cervial factors
can women with diabetes mellitus breastfeed and why?
Yes, insulin requirements decrease with breasftfeeding , so eat a prenursing snack
if a women is breastfeeding with diabetes mellitus, what calorie change does she need?
increase during lactation by 500-800kcal above pre pregnancy requirments
what happens to insulin postpartum?
decreased insulin requirements and decreased blood glucose levels
what are the recommendations of testing for HIV in pregnant women?
emphasize as routine but ensure that its voluntary and informed
what is used in intital testing of HIV in pregnant women?
4th generation HIV 1/2 antigen immunoassay
-if positive confirmatory testing is done using HIVq/ HIV2 differentiation
how can a women who has HIV reduce the risk of transmitting to baby?
Prophylatic antiretroviral throughout pregnancy, labor and birth and give ART meds to baby for 4-6 weeks
no breastfeeding
no prechewing food
How is HIV transmitted to fetus?
Placenta. amniotic membranes, breast milk, and contaminated blood
what is the test for diagnosis of HIV in newborns?
PCR and HIV RNA assay
what is the treatment for HIV in pregnant women?
ART therapy
what 5 conditions could potentially cause harm to the fetus?
Diabetes mellitus, anemia, substance abuse, HIV, and heart disease
what is glucose to the fetus and how is it transported?
the primary fuel for the fetus
transmitted across placenta by diffusion (fetus glucose is proportional to moms levels)
how does pregnancy affect diabetis mellitus in the 1st trimester?
hypoglycemia
how does pregnancy affect diabetis mellitus in the 2nd and 3rd trimester?
decrease tolerance to glucose, hyperglycemia
how does pregnancy affect diabetis mellitus during birth?
Pre pregnancy glucose levels
what are the maternal risk of diabetes mellitus?
increased difficulties with glucose tolerance control
HTN
hydramnios/polyhydramios ( increased amniotic fluid >2000ml)
infections
Ketoacidosis/hypoglycemia
preterm labor
PROM
what are the fetal risk of diabetes mellitus?
stillbirth
congenital anomalies
macrosomia (>4000gm)
respiratory distress
what are the most common congenital anomalies?
cardiac and CNS deficits
how many prenatal visits if mom has diabetes mellitus?
1 and 2 trimester every 1-2 weeks
3 trimester is 2 times a week
when is a glucose test given if mom has diabetes mellitus?
prior to 12 weeks and between 24-28 weeks
what happens during labor of a mom who has diabetes mellitus?
maternal insulin requirments drop rapidly during labor
what is the postpartum care of a mom who has diabetes mellitus?
removal of placenta will decrease insulin requirements
encourage breastfeeding
use a contraception
which anemia is most common in pregnant women and what should they take?
iron deficency, takle prenatal vitamins and iron supplements
HGB<11
what does anemia cause maternally?
tires easily
suseptible to infections
increased risk for preclampsia and postpartum hemmorage
what does anemia cause in a fetus?
low birth weight
increased risk of preterm birth
fetal hypoxia
what can alcohol cause in a fetus?
mental retardation
microcephaly
cardiac anomalies
IUGR
fetal alcohol syndrome
what can cocaine cause maternally?
Seizure
hallucinations
respiratory failure
heart problems
increased risk of spontaneous abortion
IUGR
still birth
abruptio placenta
what can cocaine cause fetally?
IUGR
microcephaly
altered brain development
congenital anomalities
what can cocaine cause in newborns?
neurobehavioral disturbances
irritability
increase risks of SIDS
feeding difficulties
what can cocaine cause in toddlers?
hyperactivity
what can smoking cause in a fetus and what are the health risks?
decreased O2 and food to fetus from placenta
- bleeding.
-spontaneous abortion
-stillbirth
-prematurity
-placenta preuia
-placenta aabruption
-LBW
-SIDS
If a women declines HIV screening what is it called?
opt out strategy
what are the cardiac diseases that can affect pregnancy?
Rheumatic fever, congenital disease, and mitral valve disease
what can hyperthyroidism cause in pregnancy?
increased risk for preclampsia and PPH
is breastfeeding contradicted in women with hyperthyroidism?
only if on antithyroid meds
what can hypothyroidism cause in pregnancy?
maternal issues are rare because they often have fertility issues
what can hypothyroidism cause r/t the fetus?
if mother is untreated, there is an increased risk of death and newborns are at high risk for neuro and congenital goiter
what are the maternal effects of tobacco?
decreased placental perfusion/vasoconstriction
increase risk for PROM, miscarriage, preterm birth, placental abruption, and placenta previa
what are the fetal affects of tobacco?
LBW from decreased placental perfusion
Nicotene withdraw symptoms
irritability
what are the maternal effects of alcohol?
HTN
miscarriage, preterm, and stillbirth
anemia
nutritional defictis
alcohol hepatitis
cirrhosis
what are the fetal effects of alcohol?
fetal alcohol syndrome
mental retardation
behavorial problems
learning difficulties
what are the maternal effects of marijuana?
it crosses the placenta and increases co2 in blood which decreases 02 in fetus
what are the fetal effects of marijuana?
LBW and tremors
what are the maternal effects of cocaine?
Tachycardia, HTN, and MI
corornary artery spasm
uterine and blood vessel spasms
liver damage
hemorrhagic bronchitis
seperation of placenta
preterm labor
what are the fetal effects of cocaine?
Preterm labor or bleeding r/t placental abruption
LBW
poor feeding
diarrhea
microcephaly
what are the maternal effects of meth?
tachycardia, HTN
weight loss
insomnia
paranoia
violent bahaviors
seixures
cardiac shock
what are the fetal effects of meth?
IUGR
preterm birth
microcephaly
agitation
vomiting
what are 2 methods to obtain FHR?
US transducer and a handheld doppler
what does the spiral electrode do?
FHR
what are early decelerations?
they mirror contraction and caused by fetal head compression
what are late decelerations?
non reassuring andd baby has a low APGAR
what is variability r/t FHR caused by?
caused by interaction of sympathetic and parasympathetic nervous system
what is occiput?
vertex/ back of head presentation
what is mentum?
face presentation
what is scarum?
breech/ butt and feet presentation
what is acromion?
shoulder and scapula presentation
