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OB > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Signs of placental separation:

A

○ Change in uterus shape from discoid to globular (as moves down and contracts)
○ Sudden gush of blood
○ Lengthening of umbilical cord
○ Palpation of tissue in the vagina

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2
Q

Nursing Interventions for Newborn(First Two Hours Recovery)

A

○ Newborn assessment q30 (fundal assessment and vital signs)
○ Administer erythromycin/vitamin K (eyes/thighs or E/T)
○ Assist with breastfeeding
○ Apgar scoring, weigh, measurements, security bands, education
○ Assist with bonding and feeding initiation

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3
Q

Nursing Interventions for Patient: (First Two Hours Recovery)

A

○ Start postpartum Pitocin (Oxytocin)
○ Maternal assessments q15 for 1st hour then q30 for 2nd hour (fundal
assessment and vital signs)
○ Pericare, pain medication, comfort measures, assist to bathroom,
education

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4
Q

2-12 hours Postpartum General Protocols: Post-Vaginal Birth

A

b
● VS and fundal checks q8-12
● Motrin and Tylenol● If epidural, as soon as wears of

●If no epidural, up to bathroom & ambulating right away

●If epidural, as soon as wears off

○May have urinary retention upon first void

●VS and fundal checks q8-12

●Motrin and Tylenol

○ May have urinary retention upon
first void
● VS and fundal checks q8-12
● Motrin and Tylenol
○ May have urinary retention upon
first void
● VS and fundal checks q8-12
● Motrin and Tylenol

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5
Q

Post-Cesarean Birth:

A

●Bedrest for ~12 hours●Foley catheter●IV fluids infusing●VS and fundal checks q4●Motrin/Toradol and/or PO narcotic

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6
Q

Uterus Assessment: Subinvolution Definition

A

●a disruption in the normal involution process

○Immediate or delayed; can cause a postpartum hemorrhage or occur due to retained placenta

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7
Q

Why does patient position matter when the RN is completing a fundal massage?

A

More accurate: as umbilical will be in a different location. Place patient supine

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8
Q

Fundal assessment documentation

A

○Firm (contracted) or boggy (soft, not contracted)

■Referring to the top of the fundus

○Midline (anatomically corrected) or deviated (pushed to the side) (means bladder is too full)

■Referring to the location of the uterus in the pelvis

○Scant, light, moderate, heavy lochia with or without clots

■Documented of fundus in relation to umbilicus

■Expected to be at the umbilicus day 0 postpartum and move at least 1 fingerbreadth below the umbilicus each day postpartum

■Examples: documented as 1↑U or 2↓U

●Measured in fingerbreadths (FB) above or below the umbilicus

■Concern if the fundus is increasing above umbilicus rather than decreasing below the umbilicus postpartum

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9
Q

BUBBLELE: Bladder

A

●Significant diuresis in the days following birth

●“Due to void” (DTV) within 4-6 hours after catheterization/most recent void

●Urinary retention is possible

○Increased risk if had epidural anesthesia or cesarean birth

●Burning with urination can occur if laceration/episiotomy

●Risk of UTI remains increased postpartum

○Further increased risk if had a catheter during hospitalization

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10
Q

BUBBLELE: Bowel

A

●May take up to 3 days before the first bowel movement postpartum

  • ○First 3 days: encourage ambulation, fluids, increase fiber-rich foods, stool softener*
  • ○3+ days without a bowel movement: discuss with provider alternatives; consider laxative in PO or suppository form and/or enemas*

●Assess presence of flatus: gas

●Post-op cesarean patients can experience trapped gas

○Important to encourage clear liquids first before a large meal postpartum

●Hemorrhoids may have been present in pregnancy

○Often aggravated with pushing in a vaginal delivery

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11
Q

BUBBLELE: Lochia

A

●Cervical os slowly closes postpartum

●Passing of menstrual-like blood until ~6 weeks postpartum

●Bleeding should slow and follow this pattern. If does not, could be a sign of a complication

  • ○Lochia rubra: Days 1-3, bright red, small clots*
  • ○Lochia serosa: Days 4-10, brown/pink*
  • ○Lochia alba: Day 10+, yellow/white*

●Color and consistency of blood gives insight into origin

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12
Q

BUBBLELE: Episiotomy/Lacerations/Incision

A

●REEDA is an important acronym when assessing wounds

●Redness

●Eccyhmosis (bruising)

●Edema

●Drainage

●Approximation○Any signs of dehiscence? (separation of wound)

●Assess lacerations from vaginal delivery and post-op incision scar○All sutures usually dissolvable; cesarean incision may have staples

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13
Q

Perineal Lacerations Degrees

A

●1st-4th degree, ranging from most superficial to deepest

1st degree: through perineal skin only

2nd degree: through perineal muscles

3rd degree: through the anal sphincter muscle

4th degree: through the anal sphincter and rectal mucosa

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14
Q

BUBBLELE: Legs

A

●Postpartum patients still at high risk for DVTs and now sometimes immobile post-op or not ambulating a lot due to recovery and time spent with newborn

●Assess for edema, varicosities, thrombophlebitis, DVT

●Assess for deep tendon reflexes and clonus if patient is preeclamptic

●Ensure SCD boots applied if patient is not ambulating

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15
Q

BUBBLELE: Emotional Status:

A

Baby blues: ~80% of patients experience

■Transient feelings of sadness, bouts of crying, overwhelm

■Lasts about 1 week

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16
Q

Rubin’s Model of Maternal Postpartum Adjustment:

A

●Taking in (dependent phase)○1st 24 hours○Focused on self and basic needs, excited, talkative, reviewing birth experience

●Taking hold (dependent/independent phase)○Lasts 10 days-several weeks○Focused on new role, optimal time for teaching and learning

●Letting go (interdependent phase)○New parent role is accepted, reestablishing relationship with partner, accepting of family unit

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17
Q

Other Postpartum Physiologic Changes: Hormonal

A

Hormonal Changes:

●Dramatic decrease in estrogen and progesterone

●Lactational amenorrhea related to increase in prolactin and oxytocin with breastfeeding

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18
Q

1st T: Tone (Uterine atony):

A

●Risk factors: full bladder, large uterus, high parity

●Assessment: boggy uterus; excessive bleeding

●Intervention: fundal massage, uterotonic medications

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19
Q

2nd T: Tissue (Retained placenta)

A

●Risk factors: preterm delivery, placental abnormalities

●Assessment: boggy uterus; excessive bleeding

●Intervention: Assess for and remove retained products

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20
Q

3rd T: Trauma (Lacerations, episiotomy, hematoma

A

●Risk factors: precipitous deliveries, OASIS, operative deliveries, macrosomia, abnormal presentation, labial varicosities

●Assessment: firm fundus, steady stream of bright red bleeding, bluish swelling near perineum; intense perineal/rectal pain/pressure

●Intervention: assess the site, hematoma evacuation

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21
Q

4th T: Thrombin (Coagulopathy)

A

●Risk factors: coagulopathy, placental abruption, OB emergency

●Assessment: bleeding from IV sites/nose

●Intervention: treat underlying cause, transfusions

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22
Q

Uterotonic Medication: (know route/and generic name)

A

●Oxytocin (Pitocin) IV

○Double rate of normal postpartum Oxytocin

●Misoprostol (Cytotec) PR

○Can cause slight increase in temperature

●Hemabate (Carboprost) IM

○Can lead to diarrhea

○Contraindicated in patients with asthma●

Methergine (methylgonovine maleate) IM

○Contraindicated in patients with hypertension

*bold is generic

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23
Q

Signs and Symptoms of Postpartum Infections:

A

fever, chills, tachycardia, foul-smelling or looking lochia or drainage, redness

*****If a fever spikes postpartum, we do not refer to it as chorioamnionitis anymore (only when pregnant) and instead endometritis

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24
Q

Postpartum Discharge Teaching: WHEN TO CALL PROVIDER

A

●Fever > 100.4, pain/redness in leg, abnormal discharge/odor, sudden increase in lochia, preeclampsia signs and symptoms (headache, vision changes, nausea/vomiting, epigastric pain)

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25
Q

Postpartum DVT: Signs and Symptoms of Thrombophlebitis: Inflammation

A

●Signs and symptoms: redness, warmth, pain, tenderness, edema, fever

●Interventions: elevate, heat, pain meds, SCDs

●Can progress to superficial thrombophlebitis, DVT, pulmonary embolism (PE)

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26
Q

Postpartum DVT: Signs and Symptoms of Thrombosis/DVT: clot formed from inflammation or partial obstruction of a vessel

A

●Similar signs & symptoms as above

●Similar treatment with addition of strict bedrest and initiation of anticoagulant

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27
Q

Ideal Newborn Vital Signs

A

●Allow a transition period for vitals to regulate

●Heart rate: 120-160○Brief fluctuations above or below normal depending on sleep/active states

●Temperature: 97.7-99.5 F (36.5-37.5 C)

●Respirations: 30-60

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28
Q

MILD signs of Respiratory Distress

A

●Nasal flaring

●Grunting

●Retractions (use of intercostal or subcostal muscles “drawing in” of tissue between ribs)

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29
Q

MODERATE/SEVERE Respiratory Distress

A

●Suprasternal or subclavicular retractions with stridor or gasping

●Seesaw or paradoxical respirations

●Circumoral cyanosis (bluish of lips/mucous membranes)

●Central cyanosis○Late sign of distress indicating hypoxemia

●Apnea > 30 seconds

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30
Q

First thing to do when you see Moderate/Severe Respiratory Distress?

A

ASSESS!!!

then…call for help.

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31
Q

Transient Tachypnea of the Newborn (TTN)

A

●Mild TTN occurs 1-2 hours post-birth●

Shows signs of respiratory distress

●May require supplemental oxygen

●Usually resolves within 24 hours

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32
Q

Newborn Thermogenesis:

A

○Newborns produce heat via nonshivering thermogenesis by metabolizing brown fat and increasing metabolic activity

○Newborns have small reserves of brown fat (the longer the gestation, the more brown fat)■This rapidly depletes with cold stress

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33
Q

Why are newborns more at risk for heat loss?

A

○Due to smaller surface area, blood vessels close to skin surface, little subcutaneous fat in newborns

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34
Q

Heat Loss: Convection

A

●Convection: flow of heat from body surface to surrounding cooler air○Example: naked baby in bassinet losing heat to cool air around them rather than being swaddled with a hat

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35
Q

Heat Loss: Conduction

A

●Conduction: flow of heat from body surface to a cooler surface in direct contact○Example: naked baby lying on a cold scale to be weighed without a blanket on it

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36
Q

Heat Loss: Evaporation

A

●Evaporation: flow of heat when liquid is converted to a vapor○Most significant cause of heat loss in the days after birth○Example: moisture vaporization from the newborn skin before dried after a bath

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37
Q

Heat Loss: Radiation

A

●Radiation: flow of heat from body surface to a cooler solid surface nearby (not directly touching)○Example: baby’s bassinet next to a window in the winter months rather than baby being far from window and any air drafts

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38
Q

Because of heat loss by convection: The ambient temperature in newborn care ares should range between what temperature and what humidity?

A

ambient temperature in newborn care areas should range between 22° and 26° C (72° to 78° F)

the humidity between 30% and 60%

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39
Q

Cold Stress Facts

A

●Increased physiologic and metabolic demands caused by hypothermia

●Symptoms: hypothermia, pale, mottled, cold skin●Can lead to and exacerbate hypoglycemia, hyperbilirubinemia, respiratory distress

●Avoid by minimizing heat loss and maintaining in neutral thermal environment

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40
Q

GI and Renal System Facts:

A

●Newborns have diuresis of excess extracellular fluid the first few days after birth○Contributes to expected weight loss < 10% of body weight●

New research is emerging about the microbiome and health and relationship between birthing person and newborn’s microbiomes○Mode of birth affects microbial colonization of the newborn○Additional factors are antibiotic use, diet, and environment

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41
Q

Hepatic System Facts

A

●Immature at birth

●Liver functions: iron storage, glucose homeostasis, fatty acid metabolism, bilirubin synthesis, coagulation, drug metabolism

●Newborns have high concentrations of red blood cells (RBCs) at birth and these RBCs have shorter life spans → ↑ bilirubin which is a byproduct of RBC hemolysis → ↑ build-up of unconjugated bilirubin that must be broken down by liver

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42
Q

Jaundice:

A

●Jaundice: yellow discoloration of skin and sclera of eyes○Appears when total serum bilirubin > 6-7 mg/dL○Risk factors: Born <38 weeks, exclusive breastfeeding, prior baby with jaundice, significant bruising during delivery

Can be harder to assess visually in darker-skinned newborns

****Jaundice usually starts in the head and progresses downward to the rest of the body

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43
Q

Bilirubin:

A

●Bilirubin: waste byproduct produced by RBC hemolysis○Two types: conjugated (easily excreted from the body) and unconjugated (insoluble and must be conjugated in liver to be excreted)

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44
Q

Hyperbillirubinemia is?

A

high bilirubin

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45
Q

_Acute bilirubin encephalopathy i_s?

A

●bilirubin toxicity when bilirubin levels are high enough to cross the blood-brain barrier

○Signs and symptoms: lethargy, irritability, seizures, coma, death

46
Q

Kernicterus: Definition and S/S

A

●irreversible long-term effects of bilirubin toxicity

○Signs and symptoms: hypotonia, hearing loss, delayed motor skills, cerebral palsy

47
Q

Icteric:

A

adjective used to describe being affected by jaundice

48
Q

●Physiologic jaundice

A

○Common (occurs in ~60% term, 80% preterm infants)○Due to high levels of unconjugated bilirubin○Presents after 24 hours of life○Usually self-resolves without treatment

49
Q

Pathologic Jaundice

A

○Less common○Presents in the 1st 24 hours of life○Usually occurs due to a medical condition and/or severely high levels of bilirubin■Common cause is blood type incompatibility (ABO or Rh incompatibility)

*more severe type of jaundice

50
Q

●Breastfeeding-associated jaundice (early-onset)

A

○Occurs at 2-5 days after birth○Hyperbilirubinemia occurs due to lack of effective breastfeeding (breastfeeding itself is not a cause)

51
Q

●Breast milk jaundice (late-onset)

A

○Occurs at 5-10 days after birth○Rare, unknown cause but likely factors in breast milk decrease ability to excrete unconjugated bilirubin

52
Q

Screening for Hyperbilirubinemia

A

●Part of newborn assessment to inspect for jaundice

●Transcutaneous bilirubinometry (TcB or TcBilli) is a monitor used on the forehead of every baby before hospital discharge○Screening tool only (not reliable if bilirubin > 15)

●If high, will obtain a total serum bilirubin level via heel stick for more accurate measurement

53
Q

Jaundice Treatment

A

●Feeding → stooling → way to excrete unconjugated bilirubin○Physiological jaundice typically resolves with increased feeding

●Hyperbilirubinemia related to pathologic jaundice and/or very high levels, may require phototherapy○Light energy used to change shape of bilirubin causing unconjugated → conjugated for easier excretion → reduces circulating bilirubin

●Exchange transfusion: most invasive treatment if phototherapy is not sufficient or if encephalopathy/kernicterus occurs○Performed in NICU where infant’s blood is replaced with donor blood

54
Q

Phototherapy:

A
  • Phototherapy does not use significant UV radiation. Opaque eye mask prevents retinal damage. Can increase heat loss via evaporation so important infant is still feeding q2-3 hours to prevent dehydration (only a diaper and eye protection) No lotion
  • Many factors vary in phototherapy causing a unique experience for each individual baby based on their clinical findings

Goal of phototherapy: “bilirubin level should begin to decrease within 4 to 6 hours after phototherapy is initiated and within 24 hours should decrease by 30% to 40%”

55
Q

Integumentary System in Baby

A

●So many NORMAL skin changes! Most self-resolve

●Vernix: prevents heat loss via evaporation; emollient, antimicrobial, and antioxidant properties; also decreases the skin pH, skin erythema, and improves skin hydration (in addition to possibly contributing to a healthy microbiome)- (white cheesy stuff)

●Lanugo:coarse body hair that will fall off

●Creases on the palms and soles of feet●

Milia:-small, whiteheads that look like baby acne

●Peeling (desquamation)

●Port wine stain (red birthmark-doesn’t resolve)

●Harlequin sign-a transient condition where half of the face appears red

●Mongolian spots- blue spots on back of rear end

●Stork bites (nevi)

●Erythema toxicum (newborn rash)

**The soles of the feet should be inspected for the number of creases during the first few hours after birth; as the skin dries, more creases appear. More creases on the palms of hands and soles of feet correlate with a greater maturity rating.

56
Q

Crytorchidism

A

failure of testes to descend; more common in preemies)

57
Q

Hypospadias vs Epispadias

A

urethra is below tip of penis)

vs

(urethra is above tip of penis)

58
Q

Molding:

A

overlapping of cranial bones during birth to allow passage through the birth canal → variations in shape of head

59
Q

Caput succedaneum:

A

● “caput” or “cone head” caused by sustained pressure during birth → compression of vessels → ↓ venous return → edema

60
Q

Cephalohematoma:

A

●blood collection between skull bone and periosteum○Does not cross suture lines; firmer and more defined than caput○Resolves within 2-8 weeks; usually occurs with caput succedaneum

61
Q

Subgleal hematoma

A

can also occur and is rare but more severe; often occurs from the shearing forces of an operative delivery

62
Q

Apgar Scoring

A

●Scores given at 1 and 5 minutes of life

●Scores are out of 10○If 5 minute Apgar is <7, will repeat again at 10 minutes of life○If 10 minute Apgar is <7, will repeat again at 15 and then again at 20 minutes (if needed)

●5 criteria, each get a score of 0, 1, or 2○Heart rate, respiratory effort, muscle tone, reflex irritability, color

●Nurse responsibility unless the pediatric team is present for delivery●Acrocyanosis normal in 1st 24 hours

●Apgar scoring does not predict future neurologic outcomes

63
Q

Apgar Score adaptation:

A

0-3 severe distress

4-6 moderate difficulty

7-10 adapting

64
Q

Apgar Heart Rate Score: 0,1,2

A

0: absent
1: Slow< 100/min
2: > 100/min

65
Q

Apgar Respiratory Score: 0,1,2

A

0: absent
1: Slow, weak cry
2: Good cry

66
Q

Apgar Muscle Tone Score: 0,1,2

A

0- flaccid

1- Some flexion of extremities

2- Well flexed

67
Q

Apgar Reflex Irritability Score: 0,1,2

A

0-No response

1- Grimace

2- Cry

68
Q

Apgar Color Score: 0,1,2

A

0-Blue, Pale

1- Body pink, extremities blue

2- Completely Pink

69
Q

Newborn Growth

A

At term >37 weeks, average measurements:

●Weight: 2500g-4000g (5.5lbs-8.8lbs)○Described in further detail based on gestational age using a growth chart○

Appropriate for gestational age (AGA): Infants between 10-90th percentile○

Small for gestational age (SGA): Infants <10th percentile○

Large for gestational age (LGA): Infants >90th percentile

●Length: 45cm-55cm

●Head circumference: 32cm-38cm

70
Q

Newborn Reflexes

A

●Some reflexes are vital for survival

●Rooting is a sign of hunger, sucking, sneezing, gagging

●Newborns are nasal breathers○~3 weeks a reflex develops causing mouth opening if nose obstructed

●Presence of reflexes reflects neurologic intactness and maturity

71
Q

I/O’s in Newborns

A

●Together with daily weights is a great indicator of feeding success

●In the first 3 days of life, the minimum # of expected wet and dirty diapers correlate with how many days old the baby is

●Meconium is first bowel movement and will transition over the next few days○Breast milk fed babies stools: black → green → yellow, seedy (sweet smell)○Formula fed babies stools: brown, thick (bad smell)

●Urine is usually straw colored and odorless○A sign of dehydration is pink-tinged uric acid crystals called “brick dust”

●Spitting up is common and normal. If excessive or appears painful, not normal

72
Q

Newborn Screening Tests

A

●Bilirubin test

●Metabolic screening required by the state

●Hearing Test

●Critical Congenital Heart Disease (CCHD): pulse oximetry on two extremities

73
Q

Routine Metabolic Newborn Screening

A

●Blood sample obtained via heel stick and sent to external lab○Results communicated with pediatric provider after discharge

●Must be performed after 24 hours for accuracy

●Required by the state

●Examples include phenylketonuria (PKU) and cystic fibrosis

74
Q

Circumcision

A

●Optional medical procedure●Often performed by an OB/GYN●Performed after 24 hours of life●Requires “circ care” post-procedure○Involves gauze and vaseline○Monitor bleeding and healing○Continues 7-10 days post-procedure based on pediatric provider’s recommendations

Nursing Interventions:

●Assist with procedure in terms of comfort, gathering equipment, positioning baby, perform time out with doctor, circ care, education to family, assess I&Os

75
Q

Prematures Risks:

A
  • no fat deposits,
  • difficulty maintaining temperature,
  • decreased immune activity,
  • immature organs (↑ risk for hyperbilirubinemia, ↓ kidney function,
  • hypoglycemia)
  • Respiratory distress due to absent or decreased surfactant, immature regulatory center, pliable thorax
76
Q

Necrotizing Enterocolitis (NEC)

A

●Acute inflammatory bowel disease●

●Bowel swells → breaks down → unable to produce its own natural defenses → ↑ risk bacterial colonization

●Risk factors: preterm infants, formula fed

●Early signs and symptoms nonspecific: fatigue, abdominal distension

●Bowel rest is indicated; when safe to resume feedings, breast milk is best

●Nursing interventions: avoid rectal temperatures, infection control

BABIES MAJOR AT RISK FOR INFECTION!!!

77
Q

Neurologic Complications

A

●Risk inversely proportional to gestational age

○Preemies have ↑ fragile cerebrovascular system, ↑ permeability of capillaries, prolonged PTT

●Hypoxic-ischemic brain injury

●Intraventricular or intracranial hemorrhage

○Ruptured vessel from ↑ cerebral blood flow to area

●Treatment: Therapeutic hypothermia appropriate for late preterm and term newborns○Body or head cooling within 6 hours after delivery improves outcomes ○Otherwise supportive measures

78
Q

Inborn Errors of Metabolism: When do we test for these?

A

At 24 hours

79
Q

Neonatal Infections and Sepsis

A

●A leading cause of neonatal morbidity and mortality●Symptoms often discrete and nonspecific○Important to catch early

Types:

●Early-onset (congenital): within 1 week of birth (often within 72 hours)

○Rapid onset○Inversely related to infant birth weight○Group beta strep (GBS) sepsis most common

●Late onset: occurs later than 1 week after birth (usually 7-30 days postpartum)○Community or hospital-acquired infections○Pneumonia and bacterial meningitis are most common

80
Q

Symptoms of Sepsis:

A

●Early symptoms: lethargy, poor feeding, poor weight gain, irritability

●Later symptoms: temperature instability (typically hypothermia), diarrhea, vomiting, decreased reflexes, pallor, mottled skin, respiratory distress symptoms

81
Q

Drug-Exposed Infants : Symptoms

A

●Symptoms: tachycardia, fever, diarrhea, projectile vomiting, nasal congestion, hyperactivity, irritability, excessive crying, perspiration, feeding issues

82
Q

Fetal Alcohol Syndrome Spectrum Disorder

A

●Fetal alcohol syndrome (FAS)○Physical and behavioral symptoms plus anatomical manifestations

■Abnormal facial features (small eyes, thin upper lip, indistinct philtrum)

■Seizures most common; also jitteriness, increased tone, hyperreflexia, irritability

●Alcohol-related neurodevelopmental disorder (ARND)

○Behavioral and cognitive disabilities

●Alcohol-related birth defects (ARBD)

○Congenital cardiac, musculoskeletal, renal, and/or auditory manifestations

83
Q

Hemolytic Disorders

A

●Most often occurs due to isoimmunization (usually Rh incompatibility)

○Less often associated with ABO incompatibility

●Most common reason for pathologic jaundice

84
Q

What type of fetal heart tracing may be anticipated for Hemolytic Disorders in infants?

A

Sinousiodal

85
Q

ABO Incompatibility

A

●When the birthing person has a different blood type than the baby and antibodies cross the placenta causing hemolysis in the newborn

●Most commonly occurs when birthing person is O and baby is not

○Due to birthing person with O blood type having anti A and B antibodies that can cross placenta

●Wide variability in maternal sensitization to Rh + antigens → wide variability in symptoms/effects

86
Q

Infants of Diabetic Mothers (IDM)

A

●“Single most predictive factor of fetal well-being in a baby born to a diabetic mother is their euglycemic status”

○Uncontrolled blood sugars in early pregnancy increase risk of cardiac and CNS anomalies

○Respiratory distress is a concern due to reduced surfactant synthesis related to maternal hyperglycemia

●Hallmark signs and symptoms: macrosomia or LGA (↑ risk for shoulder and labor dystocia) and hypoglycemia○Can occasionally manifest as growth restricted (IUGR) or SGA

87
Q

Phenylketonuria (PKU): inborn errors of metabolism

A

● autosomal recessive enzyme deficiency unable to break down phenylalanine requiring strict dietary changes

88
Q

Congenital hypothyroidism: inborn errors of metabolism

A

●variety of causes; requires thyroid hormone replacement

89
Q

Galactosemia: errors of metabolism

A

autosomal recessive leading to 1 of 3 enzyme deficiencies requiring specific dietary changes

90
Q

Respiratory Distress Syndrome

A

●Lung disease characterized by immature lung development●Almost exclusive to preterm infants; insufficient surfactant is main cause

91
Q

Respiratory Distress Syndrome Symptoms:

A

Tachypnea, Dyspnea, retractions, crackles, grunting, flaring of nares, cyanosis or pallor, apnea

*with progressed condition deteriorating vital signs including BP, apnea, and body temperature instability

92
Q

Breast Cancer Risk Factors:

A

●Similar as other cancers (age, obesity, family or personal history, unhealthy lifestyles)●Earlier menarche or later menopause●Less or later pregnancies/breastfeeding●Dense breast tissue

93
Q

Perimenopause

A

●Perimenopause: length of time between the end of regular menstrual cycles until menopause

○Large variation among patients-average length is 4 years

○Transition phase with decrease in ovarian function and hormone production

○Decrease in estrogen → side effects

○Often characterized by irregular periods, vasomotor symptoms (hot flashes), vaginal dryness, insomnia

○Pregnancy can still occur!

94
Q

Menopause:

A

●Menopause: the last menstrual period

○Cannot be confirmed until one year of no menses○Marked by a single event

95
Q

Postmenopause:

A

●Postmenopause: begins one year after the last menstrual period

○Longest phase

96
Q

Chlamydia

A

●Bacterial●Most common reported STI●Majority asymptomatic; post-coital spotting, dysuria, abnormal discharge ●PO antibiotics for patient and their partner is treatment●Pelvic inflammatory disease (PID) is most common complication●Nursing interventions: antibiotic education

97
Q

Gonorrhea

A

●Bacterial●Often asymptomatic; yellow/green discharge, menstrual changes; rectal pain; diarrhea●Ceftriaxone IM is treatment●PID is a complication●Nursing interventions: encourage condoms or abstinence until fully treated to prevent reinfection; partners in last 30 days should be screened

98
Q

Syphilis

A

●Bacterial●Types/symptoms:○Primary: Painless chancre (lesion)○Secondary: maculopapular rash, lymphadenopathy, condylomata lata ○Tertiary: multi-organ system failure, often preceded by a latent asymptomatic period ●Can progress to next stage and ultimately death if untreated○A J_arisch-Herxheimer reaction_ can occur (severe febrile reaction with headaches and myalgias within 24 hours of Penicillin treatment)●Penicillin G is treatment●Nursing interventions: Education-testing has high false positive and negative rates; monthly follow-up to ensure treatment is successful

99
Q

Human Immunodeficiency Virus (HIV)

A

●Incurable virus●HIV progresses to acquired immunodeficiency syndrome when there is depression of cellular immunity●At risk for opportunistic infections and worse disease course is co-infected with HPV●Flu-like response, sore throat, rash, weight loss●Triple drug antiviral or highly active antiretroviral (HAART) keeps viral load under control●Nursing interventions: informed consent, counseling before and after testing, ensure confidentiality, encourage more frequent STI screening

100
Q

Humanpapiloma virus (HPV)

A

●Also known as condylomata acuminata or genital warts●Most common sexually-transmitted virus●Types: 100+ strains○Most low-risk strains cause genital lesions○High-risk strains increase risk for genital tract cancers, especially cervical cancer ●Painless lesions, dyspareunia (painful sex), abnormal discharge●HPV and lesions mostly self-resolve; if don’t, colposcopy and/or loop electrosurgical excision procedure (LEEP) remove precancerous cells●Nursing interventions: determine if candidate for HPV vaccine series, educate, ensure up to date with screening

101
Q

Herpes Simplex Virus

A

●Type: Incurable virus●Types: HSV-1 (oral) and HSV-2 (anal) but can be transferred via other routes○Primary outbreak: painful and itchy lesions, flu-like symptoms, discharge○Secondary outbreaks: less severe, recurrent lesions●Antiretroviral for episodic or suppressive therapy●In pregnancy, daily preventative treatment in third trimester because outbreak at time of labor requires a cesarean●Nursing interventions: ensure pregnant patients with history start antiretroviral suppression therapy ~36 weeks, educate

102
Q

Trichomonas

A

●Protozoan●Most common STI and likely underreported●Often asymptomatic or yellow-green vaginal discharge, dysuria, dyspareunia, petechiae “strawberry spots” on cervix●Antibiotic as treatment●Nursing considerations: educate, reassure

103
Q

Vaginal Infections: Bacterial vaginosis

A

●Most common vaginitis●Anaerobic bacteria replacing healthy lactobacilli, changing the vaginal pH●Symptoms include vaginal “fishy” odor, discharge, itching●Nurse must counsel on antibiotic use and lifestyle changes

104
Q

Vaginal Infections: Yeast (vulvovaginal candidiasis)

A

●Risk factors: antibiotic use, high sugar diet, diabetes, pregnancy, immunosuppression●Symptoms include itching, white discharge, pain with urination or intercourseNurse must counsel on antifungal and alternative remedies as well as lifestyle changes

***These are NOT sexually transmitted but the change in pH of the vagina when it comes in contact with semen can increase the risk for these vaginal infections

105
Q

Contraceptive Barrier Methods: Most effective condoms

A

●Physical barrier preventing semen from entering vagina●Only contraception option that protect against STIs!●Different types:○Male and female condoms○Diaphragm: dome-shaped device that covers cervix○Cervical cap: (Femcap) 3 sizes that acts as a physical barrier over the cervix○Contraceptive sponge: sponge with spermicide and water that fits over cervix; one size fits all●Efficacy: Condoms: typical use (15% failure); Diaphragm: 4-8% with perfect use and 13-17% with typical use plus spermicide (cervical cap less)●Rare side effect of all except condoms is toxic shock syndrome (sunburn-type rash, flu-like symptoms)

●Nursing interventions: condom education; most diaphragms require fit and proper placement ; all except condoms must be kept in place for 6 hours after intercourse so spermicide can work; education about proper use and storage

106
Q

Spermicides and Phexxi

A

●Chemical barrier●Recommended for use with diaphragms and cervical caps but NOT condoms●Does not protect well against STIs and if used more than twice daily, has even been found to increase HIV transmission●Different types:○Spermicides: chemicals that reduce sperm motility; many different routes available ○Phexxi: contraceptive gel that alters the vaginal pH; applicator inserted like a tampon within 1 hour before sex; can be used with any other form of birth control to enhance efficacy (except vaginal ring)●Efficacy: spermicides have 15-29% failure rate; Phexxi 86-93% effective ●Nursing interventions: educate, especially about methods that can and can’t be mixed

107
Q

Combined Hormonal Birth Control Methods

A

●Suppresses menstrual hormones to prevent ovulation, thickens cervical mucus, and thins uterine lining●Different types: pill, patch, vaginal ring and many different formulations of the pill○Pill: taken daily, may have placebo “sugar” pills○Patch: new patch placed weekly for 3 weeks then 1 week without patch○Vaginal ring: ring inserted for 3 weeks then removed for 1 week●Efficacy: Typical use 91% efficacy (pills), <9% failure rate (patch & vaginal ring)●Side Effects depend on type of pill: depression, nutrient depletion, water retention, decreased libido●Interactions: should not be taken with anticonvulsants, TB drugs, and some HIV meds●Contraindications: history of blood clots, breast cancer, liver disorders, lactation, <6 weeks postpartum, smoking if older than 35 years of age, migraines with aura, surgery with prolonged immobilization, severe hypertension, and diabetes with vascular involvement●Nursing interventions: education, ACHES warning signs, recommend prenatal vitamins to anyone of childbearing age

108
Q

Combined Oral Contraceptive Warning Signs:

A

Abdominal pain

Ches Pain

Headaches

Eye problems

Severe leg pain

109
Q

Progestin-Only Contraception Methods

A

●Inhibits ovulation by decreasing and thickening cervical mucus, thins endometrial lining, and alters fallopian tube●Different types: pills (“Minipill”), arm implant, shot, intrauterine device○Pill: even more sensitive than COCs and must be taken within the same 3 hours every day○Shot (DMPA): 1 injection every 3 months○Arm Implant (Nexplanon): thin, rod inserted into arm and lasts up to 3 years○IUD (Mirena, Skyla, others): T-shaped device inserted into the uterus and lasts 2-5+ years depending on type●6% failure rate for DMPA shot; for implant and IUD: perfect = typical use ~99% efficacy●Side Effects: Irregular bleeding/spotting; DMPA shot side effects include temporary bone density loss and long return to fertility●Good candidates: those who combined oral contraceptives are contraindicated for●Nursing interventions: reiterate that timing is key for pills, anticipatory guidance about spotting/side effects; administer shot, educate

110
Q

Intrauterine Devices

A

●T-shaped attached to strings inserted into uterus through the cervix; hormonal IUDs work the same as progestin-only methods; non-hormonal IUDs work because copper acts as a spermicide and inflames the endometrium●Different types: non-hormonal (copper) and hormonal (progestin-only)●Perfect use = typical use (1.7% failure rate); effective for 2-10 years depending on type●Copper IUD can cause heavier and more painful periods the first year of use; increased risk of PID if infection present at time of insertion; rare risk of uterine perforation upon insertion●Nursing interventions: anticipatory guidance about insertion; educate on signs of infection; instruct on how to check strings to confirm placement

111
Q

Long-Acting Reversible Contraception (LARCs)

A

●Arm implants●Intrauterine devices●Perfect use = typical use because no room for “user error” ~99%

Signs of complications of intrauterine devices:

Period late: abnormal spotting

Abdominal pain; pain with intercourse

Infection exposure; abdominal dischage

Not feeling well, Fever or chills

String missing, shorter or longer

112
Q

Sterilization/Permanent Contraception

A

●Surgical occlusion of ova (fallopian tubes) and sperm pathways● (vas deferens) or removal of female organs (uterus and/or ovaries)●Different types: male (vasectomy) outpatient procedure or female (tubal ligation procedure)●Perfect use = typical use; failure rate < 57/1,000 for female●Reversal possible for occlusion of pathways but not always successful ●Nursing interventions: client education, ensure male patients follow-up for repeat semen analysis after 3 months; ensure 30 day mandated wait period before signing paperwork and sterilization occurs

OB (4 decks)

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