Exam 3 Flashcards
STIs & effects on newborn
Chlamydia
Gonorrhea
Genital herpes
HIV/AIDS
Syphilis
Trichomoniasis
- eye infection, pneumonia, low birth weight, preterm birth, stillbirth
- rhinitis, vaginitis, preterm birth, IUGR, ophthalmia neonatorum
- intellectual disability, blindness, seizures, premature birth, low birth w
- preterm, low birth weight, HIV positive, fetal death, miscarriage
- fetal or infant death, skin ulcers, rashes, jaundice, anemia
- premature rupture, preterm birth, low birth weight
Bacterial vaginosis s/s
Dirty gray discharge, fish like odor, liquid & abundant secretion, low WBC, clue cells in microscope
Vulvovaginal candidiasis s/s
Treatment
Burning & itching, labia are erythematous & swollen, excoriations, white pasty discharge
- Antifungal (-azol), cotton underwear
Trichomoniasis s/s
Treatment
Yellow-green vaginal discharge w/ strong odor, sex & urination discomfort, irritation & itching, PH >4.5
- metronidazole 2g PO
Human papilloma virus HPV
Progression
Prevention
Most common/ highly associated w cervical cancer
- normal, HPV infected cervix, precancerous lesion, cancer
- Pap smear & vaccines (Gardasil or Cervarix)
Genital herpes simplex stages
Treatment
Vesicles -> painful ulceration -> crusting
- antiviral therapy (acyclovir)
Syphilis treatment
Preventing STIs
Penicillin G IM injection
Education about safe sex, contraception, behavior modification
PID is a result of
S/S
Management
Ascending polymicrobial infection of upper female reproductive tract
- cervical, uterine & adnexal tenderness / abnormal discharge, abundant WBCs, tubal thickening, fever, cervical infection
- hydration, analgesics, antibiotics (doxycycline + cefoxitin, or cefotetan)
Ectopic pregnancy is
S/S
Management
Ovum implantation outside the uterus due to obstruction or slowing passage of ovum through fallopian tube
- abdominal pain, amenorrhea, vaginal bleeding, adnexal mass, scant bleeding (spotting)
- methotrexate, surgery if rupture
Placenta previa s/s
Management
Painless Bright red vaginal bleeding, spontaneous cessation then recurrence, relaxed uterus
- stable mother & fetus, bed rest, evaluate Hgb & Hct, IV fluids, Corticoids for fetus if necessary
Emergency: C-section, blood transfusion
Abruptio placenta s/s
Dark vaginal bleeding, persistent or intense abdominal pain, uterine tenderness or back pain, hypertonic uterus, uterine contractions, change of FHR, decreased fetal activity or death, mother shock & renal failure
Newborn vital signs
HR 110-160
RR 30-60
T 97.9 - 99.7
BP 50-75/30-45
Respiratory distress syndrome s/s
Nasal flaring, chest retractions, grunting on exhalation, labored breathing, generalized cyanosis, flaccid body posture
Thermoregulation heat production
NTE
Brown fat location
Production through nonshivering thermogenesis (brown fat)
- need for neutral thermal environment (body temp is maintained without increase in metabolic rate or oxygen use)
- nape of neck & back flanks where kidneys are, frontal neck down sternum to umbilicus & branches to axila
Mechanisms of heat loss
Prevention
Conduction: transfer of heat from direct contact with objects
Convection: flow of heat from body to cooler surrounding air
Evaporation: liquid converts to vapor: skin & respiration or sweating
Radiation: loss of heat to cooler solid surfaces within proximity
- keep away from outside walls, cold windows & A/C, keep out of direct cool drafts, keep wrapped in blanket
Cold stress symptoms
Increased metabolism of brown fat, tachypnea
Newborn lethargic, hypotonic & weak
Normal weight loss in infants
Newborn calorie intake
Burping recommendations
newborns lose 5-10% of their birth weight
- 110kcal/kg/day till 6 months
- stimulate frequent burping to minimize regurgitation
Stools characteristics
Breast-fed
Formula-fed
Normal # of voiding a day
- yellow-gold, loose, stringy to pasty, sour smelling
- yellow, yellow-green, loose, pasty or formed, unpleasant odor
- 6-8 voidings a day
Newborn sensory adaptations
Major reflexes
Asymmetrical moro reflex
Acute senses of hearing, smell, taste
Vision is incomplete at birth, can only focus on close objects
- gag, Babinski, Moro, galant
- may indicate a fractured clavicle or brachial palsy
Newborn behavior patterns
First period of reactivity
Period of decreased responsiveness
Second period of reactivity
- birth to 30 mins to 2 hrs, newborn is alert, moving & may appear hungry
- 30 - 120 minutes old, period of sleep or decreased activity
- 2 to 8 hours, newborn awakens & shows interest in stimuli
APGAR scoring system
Total points
Activity (muscle tone), pulse (heart rate), grimace (reflex irritability), appearance (color), respiratory effort
Rate each as 0, 1 or 2
0-3: severely depressed
4-6: moderately depressed
7-10: excellent condition
Newborn circumcision interventions
At least 12 hrs old, has voided once, has received vitamin K, has not eaten 1 hour prior, written consent
Cover tip in jelly after procedure, coated gauze, assess for bleeding & document first void
Transient tachypnea of newborn
Management
Short lived, rapid breathing
- provide oxygen, ensure warmth, observe respiratory status, allow time for pulmonary capillaries to remove fluid, IV fluids or gavage feeding
PKU is
Done where
A newborn blood screening test for treatable diseases
Heel stick is done on outer edge of heel
Newborn assessment
Physical maturity
Neuromuscular maturity
- skin texture, lanugo, plantar creases, breast tissue, eyes & ears, genitals
- posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear
Average weight & range
Average length & range
Avg head circumference
Avg chest circumference
Avg: 7.5lbs range: 5lbs 8oz - 8lbs 14oz
Avg: 50cm range: 44 - 55cm
Avg: 32 - 38cm
Avg: 30 - 36cm (2cm less than head)
Small for gestational age SGA
Characteristics
Appearance
Nursing management
- weight < 5lb 8oz, below 10th percentile,
- large head, wasted appearance of extremities; loose dry skin, reduced fat stores, decreased breast tissue, sunken abdomen, wide skull sutures, thin umbilical cord
- weight length & circumference measures, serial glucose monitoring & vital signs, early & frequent feedings; IV dextrose 10%, monitor for polycythemia
Gavage feeding is
NG tube for babies who cannot get enough nutrition by bottle or breast feedings alone
Preterm newborn characteristics
Full term newborn characteristics
- <5.5lbs, scrawny, poor muscle tone, minimal SQ fat, undescended testes, plentiful lanugo & vernix, fused eyelids, thin transparent skin, few palm & sole creases
- dry cracked wrinkled skin; meconium stained, long thin extremities, creases on soles & feet, wide-eyed & alert, abundant hair in scalp, thin umbilical cord, limited vernix & lanugo
Effects of substance abuse
Nicotine
Fetal alcohol syndrome characteristics
- neonate is small, IUGR
- microcephalic, growth restriction, poor suck, cleft or thin lip, strabismus, poor coordination, mental development delay, low nasal bridge, underdeveloped jaw
Neonatal abstinence syndrome
WITHDRAWAL acronym
Multisystem disorder of drug exposed newborn, progresses to seizures
- wakefulness: sleep <3 hrs after feeding
Irritability
Tachycardia, tremors
Hyperactivity, hyperreflexia,
Diarrhea, diaphoresis
Respiratory distress, rub marks
Apneic attacks, autonomic dysfunction
Weight loss or can’t gain weight
Alkalosis (resp)
Lacrimation (flow of tears)
Hyperbilirubinemia bilirubin lvl
Physiologic
Pathological
Jaundice assessment
- total level above 5mg
- normal during 3rd-4th day, late onset 14th day if associated with breast feeding
- first day of life increase of more than 5mg & total serum Bili is >17mg, conditions that alter bilirubin excretion
- blanching the skin, best areas are nose forehead & sternum (conjunctiva in dark skinned babies), must be in a well lit room or in daylight at a window
Visual assessment Kramers index lvl 1-5 (as level increases, serum bilirubin lvl increases)
Dystocia risk factors
Management
Shoulder dystocia management
- excessive analgesia, multiple gestation, ineffective pushing or contractions, occiput posterior position, over 8.8lbs, longer 1st stage of labor, maternal age >35, high caffeine intake, overweight
- patience, evaluate labor progress, provide support, back massage for occiput posterior, promote relaxation
- Mcroberts maneuver (thighs are flexed & abducted to straighten pelvic curve)
Suprapubic pressure to displace shoulder from above pubic bone
Labor induction is
Bishop score
Stimulating contractions before onset of spontaneous labor (rupture of membranes, use pitocin (oxytocin for induction & augmentation) , prostaglandins)
- to assess cervical favorability; scale 0-3 on cervix position, consistency, effacement, dilation, Station
Cytotec/Misoprostol indication
It is administered intravaginally or orally to induce labor
Postpartum hemorrhage causes
Uterine atony, lacerations of genital tract & episiotomy, hematomas, retained placental fragments, uterine inversion, uterine subinvolution, coagulation disorders
5 T’s - tone, tissue, trauma, thrombin, traction
Episiotomy evaluation REEDA
Redness, edema, ecchymosis, discharge, approximation
Uterine displacement & prolapse management
Pessaries for limited time, estrogen therapy, surgical repair, kegel exercises, hygiene practices
Gestational trophoblastic disease GTD
Symptoms
HCG levels
Management
- amenorrhea, severe nausea & vomiting, abnormal uterine bleeding, enlarged uterus, abdominal cramping & grape like cysts, pelvic pressure or pain
- high levels, follow levels for 6 months to detect neoplasia
- monitor hemorrhage, assess uterus, emotional support, educate about serial HCG testing
Women risk factors for infertility
Ovarian hyper stimulation s/s
Most common causes of infertility
- ovarian dysfunction, tubal/pelvic pathology, overweight or underweight, hormonal imbalances, uterine fibroids, older than 27, smoking & alcohol, STI’s
- fluid build up in stomach, chest & heart area
- low sperm count, anatomic defects, fallopian tube scarring
Cytomegalovirus prevention
Prevalence
- avoid contact with saliva, wash hands after contact, don’t share utensils drinks or toothbrushes (all with kids under 6)
- 7 per 1,000 births
Group B streptococcus GBS screening guidelines
Toxoplasmosis prevention
All pregnant women should be screened at 35-37 weeks gestation & treated
Avoid eating raw food, peel or wash all fruits & vegetables, avoid cleaning cat’s litter box
