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🤰🏾- Exam 3 Flashcards

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0
Q

Risk factors of ectopic pregnancy

A
  • hx of previous ectopic pregnancy
  • hx of std’s
  • multiple partners
  • tubal sterilization
  • infertility
  • IUD
  • multiple induced abortions
  • assisted reproductive techniques
  • infection/inflammation
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1
Q

What are the 6 types of spontaneous abortion

A

Threatened- vaginal bleeding occurs

Inevitable- membranes rupture and cervix dilates

Incomplete- dorm products of conception have been expelled but some remain

Complete- all products of conception are expelled from the uterus

Missed- fetus dies during the first half of pregnancy but is retained in the uterus

Recurrent- 3 or more spontaneous abortions

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2
Q

Signs of ectopic pregnancy

A

Missed menstrual period

Positive pregnancy test

Abdominal pain

Vaginal “spotting”

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3
Q

Linear salpingostomy vs salpingectomy

A

Linear salpingostomy- incision along the length of a Fallopian tube to remove an ectopic pregnancy and preserve the tube

Salpingectomy- removal of the tube

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4
Q

What are the signs and symptoms that suggest tubal rupture or bleeding

A

Pelvic, shoulder or neck pain ; dizziness or faintness ; increased vaginal bleeding

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5
Q

Gestational trophoblastic disease (hydatidiform mole)

A

Trophoblasts (peripheral cells that attach the fertilized ovum to the uterine wall) develop abnormally

Complete: no fetus present
Partial: fetal tissue or membranes present

**avoid uterine stimulus = embolus

-removed by vacuum aspiration then curettage

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6
Q

Clinical manifestations of hydatidiform mole

A

Vaginal bleeding

High hCG levels

Large uterus

Excessive nausea and vomiting

Early development of preeclampsia

wait 1yr to get pregnant again, continuous follow-up to detect malignancies

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7
Q

Nursing interventions for early pregnancy hemorrhagic conditions

A
  • Provide test and procedure information
  • teach infection prevention: first 72hrs greasy risk, no tampons, consult provider about sex
  • provide dietary information: high in iron to increase HnH (liver, red meat, spinach, egg yolk, carrots, raisins) high in vitamin c (citrus fruit, broccoli, strawberries, cantaloupe, cabbage, green peppers) adequate fluid intake (2500mL per day) folic acid
  • educate on reporting signs of infection: fever >100.4, vaginal odor, pelvic tenderness, malaise
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8
Q

Placenta previa

A

Implantation of the placenta in the lower uterus closer to the cervical os

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9
Q

Three classifications of placenta previa

A

Marginal- lower border is more than 3cm away from the os

Partial- partial covering of os (within 3cm)

Total- placenta completely covers cervical os

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10
Q

What is the classic sign of placenta previa

A

Sudden onset of painless uterine bleeding in the last half of pregnancy

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11
Q

What should NOT be done with placenta previa

A

No manual vaginal exams , use ultrasound to locate position of placenta

No pitocin to prevent uterine stimulation

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12
Q

Abruptio placentae

A

Premature separation of the placenta

Occurs when a clot forms on the maternal side of the placenta

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13
Q

Risk factors for abruptio placentae

A
  • cocaine use causes vasoconstriction (narrowing of blood vessels) leading cause
  • maternal hypertension, cigarette smoking, multigravida status, short umbilical cord, abdominal trauma, premature ROM, hx of premature separation of placenta
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14
Q

Clinical manifestations of abruptio placentae

A

1 bleeding

2 uterine tenderness that may be localized at the site of the abruption

3 uterine irritability with frequent low-intensity contractions and poor relaxation between contractions

4 abdominal or low back pain that maybe described as aching or dull

5 high uterine testing tone

– back pain, nonreassuring FHR patterns, signs of hypovolemic shock , fetal death, board like uterus

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15
Q

Uterine resting tone

A

Degree of uterine muscle tension when the woman is not in labor or during the interval between labor contractions

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16
Q

Signs of hypovolemic shock

A

Increased ❤️ rate

Increased RR

Decreased BP

Pale color, Cold and clammy skin

Decreased urine output

Weak, diminished, or “threads” pulses

Decreased O2 saturation

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17
Q

Nursing interventions for late pregnancy hemorrhagic conditions

A
  • monitor for signs of hypovolemic shock: tachycardia, weak peripheral pulses, decreased BP, tachypnea, decreased O2 sat, cool/pale skin
  • Monitor the fetus: tachycardia, decreased baseline variability, presence of late decelerations
  • promote tissue oxygenation: position, O2, fluids
  • fluid replacement
  • prepare for surgery
  • emotional support
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18
Q

Gestational HTN

A

Also known as PIH (pregnancy induced hypertension)

Systolic > 140 or diastolic > 90

After 20 weeks

Protein is NOT present

Can lead to chronic HTN if persists after birth

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19
Q

Mild preeclampsia

A

Unknown cause

Systolic > 140 or diastolic > 90

Develops after 20 weeks

Protein IS present in urine= proteinuria

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20
Q

Risk factors for pregnancy related HTN

A

First pregnancy

1st pregnancy for man who has previously fathered a preeclamptic pregnancy

Age > 35yrs

Anemia

Family or hx of PIH

chronic HTN or predicting vascular or kidney disease

Obesity

DM

Antiphospholipid syndrome

Multifetal pregnancy

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21
Q

Severe preeclampsia

A

Systolic > 160 or diastolic > 110

^ proteinuria

Generalized edema , weight gain , oliguria

Epigastric pain

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22
Q

Magnesium sulfate

A

Calcium antagonist and CNS depressant that acts as an anticonvulsant

Therapeutic level: 4-8 mg/dL

Antidote: Calcium Gluconate (1g at 1mL/min)

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23
Q

Nursing assessment for severe preeclampsia and magnesium toxicity

A
  • rest: on left side
  • diet: decreased Na
  • weight: daily provides estimate of fluid retention
  • VS: mag sulfate decreases RR
  • EFM
  • Breath sounds: excess moisture associated with pulmonary edema
  • DTRs: noreflex= mag toxicity/ hyperreflex= ^ seizure risk
  • urinary output: at least THIRTY mL/hr
  • LOC: drowsiness indicates therapeutic mag
  • labs: ^ creatinine, liver enzymes, or decreased platelets
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24
Q

Signs of magnesium toxicity

A
  • RR rate of less than 12
  • maternal O2 sat of lower than 95%
  • absence of DTRs
  • sweating, flushing
  • altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented)
  • hypotension
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25
Q

HELLP syndrome

A

Hemolysis, elevated liver enzymes and low platelets

Liver enzymes ^ when hepatic blood flow is obstructed by fibrin deposits / low platelets occur cuz of vascular damage from vasospasm

Deliver vaginally

R upper quadrant, epigastric or lower r chest pain

Treatment: mag sulfate and hydralazine

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26
Q

Disseminated intravascular coagulation

A

Life threatening defect in coagulation

Labs: decreased fibrinogen, platelets, increased fibrin degradation and d-dimer is present

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27
Q

Hyperemesis gravidarum

A

Persistent uncontrollable vomiting that can continue throughout pregnancy leading to serious complications

Therapeutic management: meds, fluid replacement

eat foods high in K+ and Mg+

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28
Q

Characteristics of Hyperemesis gravidarium

A
  • loss of 5% or more of pregnancy weight
  • dehydration
  • acidosis from starvation
  • elevated levels of blood and urine ketones
  • alkalosis from loss of hydrochloric acid in gastric fluids (vomiting)
  • hypokalemia
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29
Q

Home visits

low risk infants vs high risk infants

A

Low risk- recognize jaundice, family adaptation, adequacy of maternal support

High risk- specialized equipment, ensure proper electricity/heat/telephone. Medically fragile: vents, oxygen therapy, apnea monitors, trach care, tube feedings, suctioning and cAre of IV sites

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30
Q

Red flags of telephone triage

A
  • emergency situation (respiratory difficulty, bleeding) call back in 5 mins to make sure parents seek help
  • illness (fever, dehydration, change in feeding behavior, unusual rashes)
  • present problem or remedies aren’t working
  • parents affect seems inappropriate for situation
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31
Q

Car seat test

A

Infants less than 37 weeks or LBW are placed in car seat and monitored for VS and oxygen level for 90mins

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32
Q

What are the 5S’s to consoling colic

A

Swaddle

Side lying

Shushing sound

Swinging

Suck on pacifier

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33
Q

Miliaria

A

Prickly heat

Develops in infants who are too warmly dressed in any weather / may also occur in infants with fever

Appears as red base with papules or clear vesicles in the center

Treatment: remove excess clothing or lukewarm bath

**avoid ointments

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34
Q

Ways to correct regurgitation

A

“Spit up”

Caused by overfeeding

Treat: burp, smaller frequent feed, enlarge nipple hole, upright after feeding

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35
Q

Growth in first 3 months

A

Gains 1oz/day (2lb per month)

Grows 1.4inches per month

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36
Q

Infant milestones

A

Focus best within a range of 8-12 inches

By 3 months follow objects horizontally

Social smile at 1-3months

Start “cooing” at 1-4 months

Laugh at 3-6 months

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37
Q

Well baby checkups occur at what age

A

1 2 4 6 9 12 months old

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38
Q

Common signs of illness in infants

A

Temp > 100.4

Vomiting

Watery stools or significant increase in stools

Blisters, sores or rashes

Listlessness of sleeping more than usual , irritability or crying more than usual

Coughing, frequent sneezing, runny nose

Pulling or rubbing at ear , drainage from the ear

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39
Q

Seek help immediately if infant displays signs of

A

Dyspnea

Rr > 60

Retractions

Cyanosis or extreme pallor

Difficult to arouse/keep awake

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40
Q

Plagiocephaly

A

Flattening of the head which was rounded at birth , may result from prolonged lying in the supine position

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41
Q

SIDS

A

Abrupt unexplained death of an infant less than 1 year old

3rd leading cause of death in infAnts from birth -1yr

Most common cause of death in infants from 1 month-1 yr

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42
Q

Common predisposing factors for PPH

A
  • overdistention of the uterus (multiple gestation, large infant, hydraminos)
  • precipitate labor or delivery
  • prolonged labor
  • use of forceps or vacuum extractor
  • cesarean birth
  • placenta previa, accreta or low implantation
  • surgery, oxytocin, tocolytics, mag sulfate
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43
Q

Current definitions of postpartum hemorrhage

A

Blood loss of more than 500mL after vaginal birth, 1000mL after cesarean, a decrease in hematocrit of 10% or more since admission or the need for a blood transfusion

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44
Q

Management and predisposing factors for uterine atony

A

Management- Fundal massage, bimanual compression, medicine, fluid, blood replacement, hysterectomy

Factors- exhaustion, overexpansion, multi parity, prolonged oxytocin, hyper and hypo uterine contraction, retained placenta

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45
Q

Causes of early postpartum hemorrhage vs late postpartum hemorrhage

A

Early- uterine atony, trauma to the birth canal, hematoma, retention of placenta fragments,

Late- subinvolution and placental fragments that remain attached

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46
Q

Pharmacological measures to treat PPH and things to note

A
  • oxytocin
  • methylergonovine maleate (methergine) is given IM. Contraindicated in hypertension
  • carboprost tromethamine (hemabate, prostin/15M) is given IM. Contraindicated in asthma and causes diarrhea. Keep refrigerated
  • cytotec
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47
Q

Predisposing factors of retained placenta

A

Attempts to deliver placenta before it separates from the uterine wall, manual removal of the placenta, placenta accreta, previous cesarean and uterine leiomyomas

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48
Q

Therapeutic management of retained placenta

A

Oxytocin , methylergonovine , dilation and curettage , antibiotics

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49
Q

Subinvolution of the uterus

Causes, management, nursing considerations

A

Delayed return of uterus to non-pregnant state

Causes- retained placental fragments and pelvic infection

Management- methergine PO and antibiotics

Nursing considerations- education about warning signs, excessive bleeding and possible infection. Pelvic or fundal pain, backache and pelvic pressure or fullness

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50
Q

Nursing considerations/management of hypovolemic shock

A

Control bleeding , check VS q3-5 mins , give 8-10L of oxygen and draw labs for H&H, clotting studies and type and cross

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51
Q

Factors that increase the risk of thrombosis

A 
Inactivity
Prolonged bed rest 
Obesity 
Cesarean birth 
Sepsis 
Smoking 
Hx of thrombosis 
DM 
Trauma 
Prolonged labor 
Age > 35 
Dehydration
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52
Q

What are the major causes of thromboembolic disorders in pregnancy or birth

A

Endothelial injury

Causes: increased clotting factor, venous stasis, vessel injury= prolonged in stirrups/constriction/flexion

53
Q

Superficial venous thrombosis

Signs and symptoms/management

A

Signs- swelling of the extremity, redness, tenderness and warmth to CALF OR IV SITE

management- analgesics, rest and elastic support. Elevation improves venous return, warm packs

*avoid standing for long periods

54
Q

Deep venous thrombosis

Signs and symptoms

A

Pain in leg, groin, lower back or right lower quadrant. Swelling of the leg (>2cm larger than the other), erythema, heat and tenderness

No homans sign -not reliable test

Pain on ambulation, chills, general malaise and stiffness of affected leg

55
Q

Initial treatment of DVT

A 
Elevation 
Anticoagulants (lovenox, heparin) 
Analgesics 
Antibiotics 
Moist heat 
Gradual ambulation

**no Coumadin during pregnancy

56
Q

Anaphylactoid syndrome

A

Amniotic fluid embolism

57
Q

Pulmonary embolism

Signs and symptoms, management

A

Signs- dyspnea, chest pain, tachycardia , tachypnea, crackles, hemoptysis, decreased O2 sat

Management- VS, elevate HB, give O2, meds (heparin, thrombolytics)

58
Q

Puerperal infection

A

Temperature of 100.4 or higher AFTER the first 24hrs and occurring on at least 2 of the first 10 days following childbirth

Types: endometritis, wound infection, uti, mastitis and septic pelvic thrombophlebitis

59
Q

Risk factors for puerperal infection

A
  • hx of uti, mastitis, thrombophlebitis
  • cesarean birth
  • trauma
  • prolonged ROM , labor
  • excessive number of vaginal exams
  • retained placenta
  • poor general health, nutrition, hygiene
  • DM
60
Q

Endometritis

A

Bacterial infection of endometrium

Signs- temp > 100.4 within 36hrs of birth, chills, malaise, anorexia, abd pain, uterine tenderness and purulent fouk smelling lochia, tachycardia and subinvolution

Management- IV antibiotics to prevent spread to tubes and ovaries

Nursing considerations- fowlers position to promote drainage of lochia, foods high in vitamin C and protein to aid healing and PO fluids

61
Q

Wound infection

Signs and symptoms, management

A

Signs- edema, warmth, redness, tenderness and pain

Management- analgesics and warm compress or sitz baths, good hand washing technique

62
Q

UTI

Signs and symptoms, nursing considerations

A

Signs- dysuria, urgency, frequency and suprapubic pain. Hematuria. Low-grade fever begin on first or second postpartum day

Day3-4 may develop pyelonephritis (chills, spiking fever, cva tenderness, flank pain and n/v)

Nursing considerations- increase fluid intake (2500-3000mL), acidic juice (apricot,plum, prune and cranberry) 🚨no carbonated drinks/grapefruit = increase alkalinity

63
Q

Mastitis

Causes, S/S, management, nursing considerations

A

Causes- constriction , decreased immune system, engorgement

Signs- flu like symptoms (fatigue, achy muscles) temp > 102.2, chills, malaise and headache .. localized lump or wedge shaped area of pain, redness, heat, inflammation and enlarged axillary lymph nodes

Management- antibiotics and continued breastfeeding or pumping from both breasts

**untreated may result in abscess

Nursing considerations- breastfeed q 2-3hrs, warm press, start BF on unaffected side 1st, massage

64
Q

Newborn calorie needs

A

100-115 kcal/day

Breastfed: 39-45 kcal per pound

Formula: 45-50 kcal per pound

65
Q

Fluid needs of the newborn

A

27 to 45mL/lb (60-100mL/kg) for the first 3 to 5 days of life

Gradually increasing to 68 to 80mL/lb (150-175mL/kg)

66
Q

Lactogenesis I, II, III

A

I- begins at 16wks gestation to day 2-3 of birth. Colostrum is rich immunoglobulin A which helps in GI tract protection

II- from day 2-3 to day 10. Transitional milk. Lactose, fat and calories increase

III- mature milk. Contains 20 kcal/oz

67
Q

Nutritional composition of breast milk

A

Protein: less amount than cows milk

Carbohydrate: lactose

Fat: 50% of calories in breast milk

Vitamins: no vitamin d - supplement 400 IU is recommended (via present in formula)

Minerals: iron in breast milk, not formula

Enzymes: pancreatic amylase, lipase for fat digestion

68
Q

Benefits of breastfeeding

A

Infant - allergies less likely to develop, helps prevent infection and disease, easier digestion, nutritional content, decreased incidence of overfeeding, constipation less likely

Mom - oxytocin release enhances involution, less blood loss, delayed ovulation, reduction in incidence of some cancers, bonding, convenience and economical

69
Q

Formula for infants with special needs

A

Soy formulas may be given to infants with galactosemia or lactase deficiency and to those whose families are vegetarians

70
Q

Factors influencing choice to breastfeed

A

Personal knowledge and past experiences

Support/education from others

Culture

Employment/school

71
Q

LATCH assessment

A

L- latch

A- audible swallowing

T- type of nipple

C- comfort (breast or nipple)

H- hold (positioning)

72
Q

Hunger cues in infants

A

licking or sucking movements

Lip smacking

Rooting

Hand to mouth movements

Sucking on the hands

Increased activity

Crying (a late sign)

73
Q

Foremilk vs hindmilk

A

Foremilk- watery first milk that quenches the infants thirst

Hindmilk- comes at the end of the feeding. Richer in fat, more satisfying and leads to weight gain

74
Q

Signs an infant is having breastfeeding problems

A
  • falling asleep after feeding for less than 5 minutes
  • refusing to feed
  • smacking or clicking sounds while on breast
  • lower lip turned in
  • failure to open the mouth widely at latch-on
  • dimpling of the cheeks
  • short choppy motions of the jaw
75
Q

The football hold is good for which scenario

A

Avoids pressure against an abdominal incision

76
Q

The cross-cradle is helpful for which scenario

A

Preterm or have a fractured clavicle

77
Q

The side lying position is good for what scenario

A

Avoids pressure on episiotomy or abdominal incisions

78
Q

Contraindications of breastfeeding

A

Drug abuse , active untreated TB, HIV, galactosemia band maternal chemotherapy

**moms on methadone or buprenorphine, hepatitis A/B/C are allowed to breastfeed

79
Q

Milk storage

A

5hrs at room temp

5 days in fridge

5 months in freezer

80
Q

Polydipsia/polyuria/polyphagia

A

Polydipsia- increase thirst

Polyuria- excessive urination

Polyphagia- excessive hunger

81
Q

Effect of pregnancy on fuel metabolism

A

Early pregnancy - metabolic rates and energy needs change little. Increased insulin release. HYPOGLYCEMIA may occur

Late pregnancy - increased placental hormones create insulin resistance. HYPERGLYCEMIA may occur

Birth- maintenance of normal maternal glucose levels is essential to reduce neonatal hypoglycemia

Postpartum - the need for additional insulin falls

82
Q

Classifications of DM

A

Type 1- insulin deficient

Type 2- insulin resistant

GDM A1- diet controlled

GDM A2- diet and insulin controlled

83
Q

Maternal effects of Preexisting DM

A
  • increased incidence of spontaneous abortion
  • fetal malformations
  • preeclampsia
  • development of ketoacidosis
  • increased UTI
  • hydramnios
  • premature ROM
  • macrosomia increased likelihood of cesarean and risk of PPH
84
Q

Fetal effects of preexisting DM

A
  • congenital defects (neural tube defects, caudal regression syndrome, cardiac defects)
  • macrosomia increases risk of cesarean or shoulder dystocia
  • sga
  • IUGR
  • oligohydramnios
85
Q

Neonatal effects of preexisting DM

A

Hypoglycemia , hypocalcemia , hyperbilirubinemia and respiratory distress syndrome

86
Q

Risk factors for gestational DM

A 
Overweight 
Maternal age > 25 years 
Previous GDM 
hx of diabetes in a close relative 
Member of high risk group
87
Q

Insulin therapy in 1,2,3 trimester, during labor and postpartum period

A

1st- decreased insulin need

2nd and 3rd- increase

During labor- maintenance of tight maternal glucose control during birth is desirable to reduce neonatal hypoglycemia

Postpartum period- insulin needs should decline rapidly after the delivery of the placenta and abrupt cessation of the placental hormones

88
Q

Glucose challenge test

A

Administered between 24 and 28 weeks of gestation.

Mom ingests 50g of oral glucose solution

A blood sample is taken 1 hour later - > 140mg/dL

89
Q

Oral glucose tolerance test

A

Gold standard for diagnosing diabetes

Mom must fast from midnight on the day of the test, then ingest 100g of glucose solution. positive GDM if fasting is abnormal or 2 or more values occur

Fasting > 95
1 hour > 180
2 hours > 155
3 hours > 140

90
Q

Signs and symptoms of maternal HYPOglycemia

A 
Shakiness (tremors) 
Sweating 
Pallor, cold clammy skin 
Disorientation; irritability 
Headache 
Hunger 
Blurred vision
91
Q

Signs and symptoms of maternal HYPERglycemia

A 
Fatigue 
Flushed, hot skin 
Dry mouth; excessive thirst 
Frequent urination 
Rapid, deep breaths, door of acetone on breath 
Drowsiness; headache 
Depressed reflexes
92
Q

Rheumatic heart disease

A

Complication that follows strep throat

Causes scarring of the ❤️ valves , resulting in stenosis (narrowing) of the openings between the chambers of the heart.

Leads to pulmonary hypertension , pulmonary edema , chf

93
Q

Intrapartum management of cardiac disease

A
  • Careful I/O
  • Position: on side, with head and shoulders elevated
  • O2
  • monitor
  • vaginal delivery
94
Q

Postpartum management of cardiac disease

A
  • may experience cardiac decompensation
  • observe closely for signs of infection, hemorrhage and thromboembolism
  • observe for signs of chf
  • observe for decreased urine output
95
Q

Signs and symptoms of chf

A

Cough (frequent, productive, hemoptysis)

Progressive dyspnea with exertion

Orthopnea

Putting edema of legs and feet or generalized edema of face, hands or sacral area

Heart palpitations

Progressive fatigue or syncope with exertion

Moist rales in lower lobes, indicating pulmonary edema

96
Q

How do you apply the nursing process in pregnancy and heart disease

A
  • assessment
  • telemetry
  • VS
  • educate on no weight gain , anemia
  • 2200 cal diet
  • rest
  • avoid extreme temps
97
Q

A pregnant woman is considered anemic if her hemoglobin level is less than

A

10.5 or 11 g/dL

98
Q

The primary sources of iron in food are

A

Meat, fish, chicken, liver and green leafy vegetables

99
Q

Signs and symptoms of iron deficiency anemia

A

(Most common type)

Pallor, fatigue, lethargy and headache

Inflammation of lips and tongue and Pica

100
Q

Iron is best absorbed if taken with

A

Meals and vitamin C

101
Q

Thalassemia

A

Genetic disorder that involves abnormal synthesis of alpha or beta chains of hemoglobin

Leads to decreased lifespan of RBC

102
Q

Folic acid consumption during pregnancy and foods to obtain it from

A

Women of childbearing age consume 400mcg daily

600mcg daily when pregnancy is confirmed

Foods- fortified greens, beans (black and lentil), peanuts and fresh green leafy vegetables

103
Q

Antiphospholipid syndrome

A

Autoimmune condition that produces antiphospholipid antibodies - body rejects pregnancy

Low-dose aspirin and prophylactic heparin are recommended

104
Q

Bell’s palsy

A

Sudden unilateral neuropathy of the 7th cranial (facial) nerve that causes facial paralysis with weakness of the forehead and lower face

105
Q

Name the 5 viral infections in pregnancy

A

1 hepatitis B - infectious liver infection, transmitted by blood & body fluids

2 rubella - transmitted through droplets or contact with nasopharyngeal secretions , common congenital disorders include developmental delay, hearing loss, cardiac defects, cataracts, IUGR, microcephaly

3 varicella zoster - transmitted by direct contact or through respiratory tract, immune prior to pregnancy, VZIG ** chicken pox in preg=pneumonia

4 cytomegalovirus - spread through contact with body fluids, primary prevention is hand washing

5 parvovirus b19 (5ths disease) - transmitted through respiratory secretions or blood, “slapped checks” rash, fever, malaise, maybe fatal to baby

106
Q

Non-viral infections in pregnancy (3)

A

1 taxoplasmosis - transmitted via raw or undercooked organisms (handling a litter box), treated with sulfonamides/combination therapy, NEONATAL EFFECTS: abortions or other serious complications

2 group b streptococci - bacterium in vagina/rectum/cervix/urethra , often asymptomatic- cultures @35-37 weeks, treated with PCN/cephazolin/clindamycin, NEONATAL EFFECTS: sepsis, pneumonia, meningitis

3 tuberculosis - transmitted to neonate from amniotic fluid ingestion or respiratory droplet inhalation , NEONATAL EFFECTS: failure to thrive/rds, treated with isoniazid and rifampin

107
Q

Visceral pain vs somatic pain

A

Visceral- dull, can’t pin point, 1st stage
Uterus contracting

Somatic- more specified, sharp, quick, end of 1st and 2nd stage , fetus puts pressure on maternal tissue

108
Q

What are the 4 sources of pain in childbirth

A
  • tissue ischemia
  • cervical dilation
  • pressure and pulling on pelvic structures
  • distention of the vagina and perineum
109
Q

What factors influence tolerance of pain

A

Labor intensity

Cervical readiness

Fetal position: occiput posterior

Pelvic readiness: size and shape

Fatigue and hunger

Caregiver interventions

anxiety and fear = ^ muscle tension

110
Q

Nonpharmacologic pain management during childbirth

A

Relaxation

Cutaneous stimulation

Hydrotherapy

Mental stimulation

Breathing techniques

111
Q

Epidural block

A

Given in epidural space

Adjust amount of anesthetic with opioid for motor function

Wait until at least 5cm dilated

No pain felt , but can still feel pressure

112
Q

Epidural blocks are contraindicated in

A

Bleeding disorders, uncorrected hypovolemia, infection, allergy, scoliosis

113
Q

effects of epidural block

A

-maternal hypotension (give bolus of fluid, change position, ephedrine and O2)

  • bladder distention
  • prolonged second stage
  • catheter migration
  • can feel brief shock in leg
114
Q

Treatment for Dural puncture headache

A

IV fluids

Bed rest

Caffeine infusion

Blood patch- uses patients blood to patch up CSF leak

115
Q

Subarachnoid (spinal) block

A
  • uses 25 or 27g needle to go deeper into the subarachnoid space (L4 and L5)
  • rapid onset, single dose
  • lose sensory and motor functions
  • used in c-section, forcep delivery or other high risk
  • bolus to prevent hypotension
116
Q

What 3 drugs are usually used for active labor/blocks

A

Meperidine (Demerol)

Morphine sulfate (duramorph)

Fentanyl (sublimaze)

117
Q

What 2 drugs have a sealing effect , which means giving more meds will NOT offer more relief

A

Butorphanol (stadol)

Nalbuphine (Nubian)

  • mixed agonist and antagonist drugs-
118
Q

Which medicine can be used on relieve puritis during labor

A

Naloxone (narcan)

119
Q

Barbiturates

A

A sedative that has prolonged depressant effects on the baby

Small dose maybe given to promote rest if mom is fatigued from false labor or a prolonged latent phase

120
Q

When is the best time to medicate mom before , after or during a contraction

A

Medicate at the beginning of a contraction for limited transfer to fetus

121
Q

What is the biggest concern for general anesthesia

A

Nonreassuring fetal hear tones and respiratory distress

122
Q

Cricoid pressure in general anesthesia

A

Or Sellick’s maneuver

Used to prevent vomit from entering the woman’s trachea while she is being intubated for general anesthesia - obstructs esophagus

123
Q

Local infiltration anesthesia

A

Numbs the perineum for episiotomy or laceration repair

Not for labor pain

No effect on the baby 👶🏾

124
Q

Pudendal block

A

Anesthetize the lower vagina and part of the perineum to provide anesthesia for an episiotomy and vaginal birth using low forceps

Given transvaginally with a 6in needle

125
Q

Magnesium hydroxide

A

Postpartum laxatives

126
Q

Should ibuprofen be given on an empty stomach ?

A

No - take with food because it causes gastric irritation

127
Q

Acetaminophen&codeine

A

Tylenol 3

128
Q

Hydrocodone acetaminophen

A

Vicodin, lortab, norco

129
Q

Oxycodone acetaminophen

A

Percocet

130
Q

Benzocaine (dermoplast)

A

Numbing spray

131
Q

Name 3 drugs used to treat hemorrhoids

A

Witch hazel (tucks) *also for episiotomy

Dibucaine ointment (nupercaine)

Hydrocortisone acetate

Nursing School (36 decks)

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