Exam 3 FC's Flashcards
1
Q
4th trimester
A
postpartum or puerperium-about 6 weeks, till mom is back to normal
2
Q
involution
A
the changing of the uterus back to the nonpregnant state. After 24hrs will be about at bellybutton. After 10-14 days it will not be palpable. It decreases about 1cm per day
3
Q
subinvolution
A
the failure of the uterus to shrink back to the prepreg state, can be caused by retained placental fragements or infection, more common in PTL, major cause of PPH. Avoid fundal massage until placenta is out
4
Q
autolysis
A
self destruction of excess hypertrophied tissue. Helps uterus return to normal size
5
Q
factors that slow involution
A
prolonged labor, anesthesia, pain meds, grand multiparity, full bladder, fragments left in uterus, Mg sulfate
6
Q
mg sulfate
A
relaxes uterus and delays its shrinking after birth
7
Q
factors that help involution
A
quick birth, ambulation, complete expulsion of placenta, breastfeeding-releases oxytocin
8
Q
causes of death in postpartum women
A
1 is cardiovascular disease, then PP hemmorhage
9
Q
what causes contractions
A
oxytocin released from pituitary
10
Q
afterbirth pains
A
not common in primivs d/t to inc uterine tone, stronger in multivs since there uterus is bigger and less elsatic, also polyhydramnios, multiple fetuses, or retained fragments
11
Q
exfoliation
A
healing and repairing of inside of uterus from placental tearing-takes about 16 days
12
Q
comfort care for perineum with lacerations
A
warm water or sitz bath, ice packs, topical anestheitcs, AVOID CONSTIPATION, no sex,
13
Q
horms PP
A
all horms decrease back to pre preg levels
14
Q
menstration PP
A
non breast feeding moms may start cycle as early as one month. Breast feeding moms usually 3-6mo up to 18mo. First period will be heavy
15
Q
diastasis recti
A
seperation of ab muscles
16
Q
urinary system PP
A
bladder distention and dilation of urinary tract-can cause uterine displacement, bleeding, and uti. Decreases urge to void, may have proteinuria for few days, BUN inc,
17
Q
blood loss during labor
A
norm for vag-300-400ml, c/s-800-1000ml
18
Q
PP vitals
A
may have bradycardia 50-70bpm, resp back to norm, BP may be high d/t PIH, or low d/t orthostatic hypotension or hemorrhage, temp should not exceed 38, 0r 100.4, cardiac output remains high for couple days d/t inc in fluids returning to circulation
19
Q
blood levels PP
A
H/H inc d/t blood loss, WBC may be up to 25. H&H drawn first post op day
20
Q
why does carpal tunnel go away after birth
A
b/c a dec in fluid relieves press on the nerve
21
Q
why do PP women sweat more?
A
to get rid of retained fluids, may have shivering and tremors d/t fluid loss
22
Q
when does mom leave PACU
A
when she has completely recivered from effects of anesthesia. A&Ox3, norm resp, 02 95+, can raise legs, flex knees, no numbness or tingling in legs
23
Q
how do nurses prevent excess bleeding in PP mom?
A
maintenance of uterine tone, prevention of bladder distention
24
Q
timeframes for discharge
A
moms stay at least 48hrs for vag delivery, and 96hrs for c/s. This the law, they can leave sooner if they want to and MD signs off on it
25
phases of parental grief
acute distress(shock numbness, intense crying, dep), intense grief (loneliness, guilt,anger, fear,anx, sadness,physical sym), reorganization(search for meaning, returning to norm activities, future planning)
26
what culture is most likely to experience perinatal loss?
African Americans
27
attachment
process by which a parent comes to love and accept a child
28
bonding
period after birth where mom and dad have close contact with child, this helps later development of child
29
mutually
the infant's behaviors and characteristics call forth a corresponding set of maternal characteristics. Ex baby smiles and mom gets excited
30
acquaintance
part of parental attachment where mom and baby are getting to know each other through touching, eye contact, and exploring
31
claiming process
the process of identifying the new baby
32
contact with baby
early contact is good for baby, extended contact helps parents bond with child
33
bio rhythmicity
fetus is in tune with mom's HR in uterus, so after birth baby will recognize mom's HR and tune in to it
34
reciprocity
baby moves or acts in response to certain things. Ex doorbell makes them cry
35
synchrony
the "fit" between the infant's cues and the parents response
36
signs baby needs change of activity
turn head away, arch back, or cries.
37
engrossment
father's absorption, preoccupation and interest in the infant
38
post partum hemorrhage (PPH)
more than 500ml for vag birth or 1000 for C/S. Can occur early-within 24hrs (uterine atony,trauma, or retained fragments) or later 24hr-6wks (retained fragments, subinvolution, endometritis)
39
normal placental seperation
has detachment phase-where contractions cause shearing of placenta off uterus. Expulsion phase-where placenta is extruded from uterus into vagina
40
active management PP
MD's now give pit before placenta comes out to shorten latent phase and dec PP bleeding
41
4 T's of PPH
Tone-uterine atony (most common), Trauma (lacerations), Tissue (retained products), Thrombin (clots)
42
uterine atony
failure of uterine musc to cont. Possible causes-anything that over extends uterus such as big baby, polyhydramnia, lots of kids, twins, use of Mg sulfate, Pit, rapid labor, prolonged labor, forcepts, maternal anemia, infection, Hx of Hemorrhage
43
D&C vs D&E
D&C-dilation and curettage-dialating cervix and removal of lining by scraping. D&E-dilation and evacuation- dilating cervix and removing contents of uterus (abortion)
44
what can cause pressure type pain in PP woman
hematoma
45
nursing care for PPH pt
assess placenta for intactness, watch lochia closely, massage fundus, keep bladder empty, IV pit, or methergine, LR, NS or blood products
46
inversion of uterus
when uterus turns inside out and starts to excape. D/T someone pulling on cord. Can be complete-its visible or incomplete-can be palpated. Need to push it back in
47
hematoma
blood escaping into conn tiss, can occur up to 3 days post op, causes severe perineal or rectal pain, PRESSURE type pain, may cause perineum to be red, edematous, bruised.
48
nursing care for hematoma
prevention and early detection are best, but if not caught check vitals, call MD
49
DIC
disseminated intravascular coagulation-clotting and bleeding at the same time. Can be d/t amniotic fluid mixing with mom's blood, abruption, fetal demise, preeclampsia, septicemia, hemorrhage, or cardiac arrest
50
risk factors for clots in preg women
uterus pushes down on vessels and slows drainage to legs, leads to stasis, also mom's blood is very thick, C/S, obesity, smoking, inactivity, being in stirups for hours. Watch for pain and swelling in legs
51
S/S of DVT
Homen's sign, lower ext pain, redness, warmth, swelling, apprehension, cough, inc HR, inc Temp
52
S/S of PE
dyspnea, sweating, pallor, cyanosis, confusion, hypotension, cough, inc RR, HR and Temp, SOB, JVD, chest pain, fear, anxity, friction rub
53
Nursing care for pt with DVT
avoid prolonged use of stirrups, early ambulation, avoid crossing legs, bedrest, monitor for bleeding
54
parametritis
inf in conn tissue adjacent to uterus
55
localized puerperal
inf in uterus that can travel up, d/t MD not wearing gloves
56
risk factors for post partum dep
teenage moms, African Americans, didn't graduate high school, Hx of dep
57
postpartum psychosis
severe post partum dep, with delusions, and thoughts of hurting self or baby, occurs up to 8 wks after birth, if mom has it for one preg she will prob have it for next preg
58
first symptom of PP inf
fever greater than 38 for 2 days in a row
59
what is methergine used for?
for PP hemorrage, do not give if pt has high BP
60
chorioamnionitis
inf in amniotic fluid
61
amenorrhea
absence of menstrual flow, can be d/t preg, stress, eating disorders, HPA problems, excessive exercise. Called hypo gonadotropic amenorrhea when d/t horm issues
62
CPPD
cyclic perimenstrual pain and discomfort-this is an umbrella term for sym that occur before and after menstrual flow developed by nurses that includes: dysmenorrhea, PMS, PMDD
63
dysmenorrhea
very common, pain and cramping, Can be primary-no cause, or secondary-d/t to some pathology like endometriosis or polyps. Tx NSAIDS, heat, prostaglandin inhibitors, massaging lower back, yoga, pelvic rocking, dietary-low salt, sugar, meat,dairy, inc fluids and diuretic foods or removal of lady parts, oral contraceptives
64
PMS
premenstrual syndrome-sym occuring in luteal phase of menstrual cycle, include physical, psych and behavioral sym, must have ovaries to have PMS
65
PDD
premenstrual dysphoric disorder-severe version of PMS with emphasis on mood symptoms, if they have 4-5 sym of PMS then they have this.
66
endometriosis
presence of endometrial tiss outside uterus, will grow during cycle every month, causes dysmenorrhea, deep pelvic dyspareunia (painful intercorse), abnormal bleeding, and infertility. Tx depends on severity, meds to spress estrogen, pain meds, or removal of lady parts-TAH, BSO
67
TAH
total abdominal hysterectomy-removal of uterus
68
BSO
bilateral salpingo oophorectomy-removal of ovaries and fallopian tubes
69
oligomenorrhea
dec in menses, or longer interval between menses, or shorter menses, can be caused by HPA issue. First couple years of period may be irregular and last couple years of period
70
hypomenorrhea
scanty bleeding at normal intervals, time period is the same, but less bleeding, caused by OCPs, structural abnormalities, or Asherman syn-destruction of endometrium
71
OCP
oral contraceptive pills
72
metrorrhagia
excessive bleeding in duration or amount or at a time other than normal menses, can be caused by OCP, IUD, IVF, miscarriage, etc. Can cause horm disturbances, systemic disease like lupus or hypothyroidism, cancer, inf, miscarriage, fibriods
73
DUB
dysfunctional uterine bleeding-excessive bleeding with no known cause, occurs at extremes of woman's mences either young or old, is affected by obesity, thyroid issues, endocrine issues, and polycystic ovaries. Can do biopsy to check it out, Tx horm therapy, D&C, ablation of endometrium, or hysterectomy
74
menopause
cessation of menses defined by no menstrual flow or spotting for 1 year, occurs in really old women (ages 40-50), is a year long process where horm prod decreases and cycle eventually ends, FSH will inc to try and stimulate ovulation. Can occur instantly by removal of ovaries and uterus
75
S/S of menopause
atrophy of vagina and urethra, dryness, vaginitis, dyspareunia, inc urinary freq, dysuria, uterine prolapse, stress incontinence, hot flashes d/t vasomotor instability, mood and behavior changes, insomnia
76
dyspareunia
painful intercorse d/t smaller vagina, dryness, and thinned walls
77
what two serious things can menopause cause?
osteoprosis and coronary heart disease
78
osteoprosis
dec bone mass, breakdown of bone exceeds building of new bones, makes them shorter, have dowager's hump, back pain, and more likely to have fractures. Tx Ca with vit D, exercise, meds to delay bone loss (boniva, actonel, fosamax, horms, etc)
79
risk factors for osteoprosis
inadequate Ca intake when younger, excesive caffeine intake, smoking, alcohol, steroids, hyperthyroidism
80
how does too much soda affect bones
soda contains lots of phos which takes the place of Ca
81
how does menopause affect the heart
estrogen dec LDL and inc HDL and has antiatherosclerotic affects on arteries, therefore when estrogen is dec body looses those benefits
82
horm therapy for menopause
is controversal b/c it may help with osteoprosis but it can inc risk for certain types of cancer and hasn't been shown to help with heart disease, also lots of side effects of taking horms.
83
how does estrogen prevent bone loss
it increases the calcitoning levels to prevent bone resorption and maintains bone density, therefore when estrogen dec then bones start to dec
84
Types of STI
chlamydia, HPV, gonorrhea, Herpes type II, syphilis, HIV
85
chlamydia
most common type, baby can get during delivery, can be asymptomatic, S/S can cause infertility, stillborn, abnormal discharge, painful urination, low back or ab pain, N,V,fever, painful intercorse, cervix is inflammed
86
how does chlamydia cause infertility
it makes the fallopian tubes slick so ovum does not stick to it
87
chlamydia affects on preg
PROM, PTL, PP inf, infertility, PID, inc risk for ectopic preg. Baby can get conjunctivitis or pneumonia
88
Tx for chlamydia
doxycycline, azithromycin, or amoxicillin
89
Gonorrhea
bacteria that grows in reproductive tract, urethra, mouth, throat, eyes and ears. Causes painful urination, white/yellow/green discharge, swollen painful testes, ab pain, fever, painful menses
90
gonorrhea affects on preg
PROM, PTL, inc risk for inf, miscarriage, PP sepsis, conjunctivitis, IUGR
91
Tx for gonorrhea
anti-infective- Rocefin (ceftriaxone) IM
92
syphilis affects on preg
PTL, miscarriage, stillbirth, inf, anemia, CNS disorder
93
Tx for syphilis
penicillin-if allergic then they must be desensitized to it. 2 injections given for 3 wks
94
Pelvic inflam disease (PID)
inf that affects fallopian tubes, uterus and/or ovaries, most commonly caused by chlamydia or gonorrhea, can make woman sterile. S/S ab pain, fever, N/V, vaginal discharge, painful urination and intercorse, pus in urine, irreg bleeding
95
risk factors for PID
sexually active without condoms, recent IUD insertion, douching, vaginal child birth or nulliparity
96
human papillomavirus (HPV)
more than 40 types, divided into 2 groups-Nononcogenic-(types 6&11) genital warts, resp inf, and mild pap abnormalities. Oncogenic-(types 16&18) mod to severe pap abnormalities, cervical dysplasia, and cervical cancer. Most HPVinf are transient and asymptomatic
97
two most common manifestations of HPV
genital warts and cellular abnormalities on pap smear
98
condylomata acuminata
cauliflower like genital wart from HPV
99
classifications of cellular abnormalities
ASC-US, ASC-H, LSIL, HSIL
100
ASC-US
Atypical squamous cells of undetermined significance- mild changes d/t to HPV.
101
ASC-H
Atypical squamous cells high grade squamous intraepithelial lesion, are associated with precancerous abnormalities
102
LSIL
low grade squamous intraepithelial lesion-usually transient, caused by HPV inf
103
HSIL
high grade squamous intraepithelial lesion- generally d/t persistant inf with high risk type of HPV, have a high risk for progressing to cervical cancer
104
Tx for HPV
topical podofilox 0.5% gel, Imiquimod cream, cryotherapy, podophyllin resin, trichloroacetic acid (TCA), bichloroacetic acid(BCA)
105
topical podofilox 0.5% gel
applied to warts BID for 3 days, then stop for 4 days and repeat if necessary. Don't use if preg
106
Imiquimod cream
apply daily at bedtime 3 times a week for up to 16 weeks, wash with soap and water 6-10hrs later. Don_t use if preg
107
cryotherapy
freezed off wart, done by provider every 1-2 wks
108
podophyllin resin with benzoin
apply a small amount to each wart and allow to airdry, done by provider
109
Trichloracetic acid or bichloracetic acid
apply small amount to warts and allow to airdry, may be repeated weekly if needed. Done by provider
110
Tx for HPV if preg
can use cryotherapy, TCA, BCA and surgical removal, may do C/S
111
teaching for HPV
tell pts to watch for reocurrences, get regular pap smears , no sex until warts are gone, tell sex partners about warts
112
herpes
type I is upstairs-blisters on mouth not STI, type II is downstairs-transmitted by sex, is a virus with NO cure, most don't know they have it
113
Herpes simplex II
2 wks after transmission of virus will have painful lesions around genitals then may be asymptomatic or mild until stress, fever, trauma, menstration, or illness causes it to have a breakout
114
Herpes II affects on preg
inc rate of miscarriage and cervical cancer, neonatal herpes (potentially fatal or severely disabling)
115
Tx for herpes II
zovirax (acyclovir) can be used in preg but risky. Valtrex-used in non preg. May do C/S
116
HAV
acquired through fecal-oral route, or contaminated food. S/S flulike sym, malaise, anorexia, N, pruritis, fever, RUQ pain. Vaccine is available. IGG can be given to preg women exposed to HAV
117
HBV
acquired through sex, blood, breast milk, can be very bad for fetus. S/S in mom fever, fatigue, N,V, ab pain, dark urine, clay colored stool, jaundice (liver is failing). No specific Tx, but vaccine is available
118
HCV
most common type of hep, acquired through sex, needles, blood, etc. Most commonly from mom INJECTING IV DRUGS. S/S flu like sym or asymptomatic. Tx interferon alpha and/or ribaviran for 6-12 months
119
vaginitis
inf caused by microorganism (usually trichomoniasis), aka abnormal vag discharge
120
bacterial vaginosis (BV)
inf changes pH of vag, can cause PTL. Tx is flagyl, do not breast feed while taking flagyl
121
candidiasis
yeast inf, S/S pruritis, painful urination, thick white cheesy discharge. Dx-pH test Tx- intravaginal agents (monistat), oral fluconazole (diflucan), and comfort measures
122
risk factors for yeast inf
abx, diabetes, preg, obestity, diet high in sugar, steroids, immunocompromised
123
trichomoniasis (Trich)
usually sexually transmitted, common cause of vaginitis, S/S yellowish/green, frothy odorus discharge, painful urination and intercourse, strawberry spots on cervix and vag wall. Dx- speculum exam and pap smear Tx-Flagyl for her and partner
124
Group B streptococcus (GBS)
normal vaginal flora in many women, can cause newborn sepsis, pneumonia, and meningitis, women are screened near end of preg and treated prior to labor
125
dystocia
obstructed labor or difficult labor
126
effects of STIs on preg and fetus
preg-PROM, PTL, PP sepsis, dystocia, miscarriage. Fetal effects- preterm birth, pneumonia, systemic/congenital inf, stillbirth
127
TORCH
titer tests for: Toxoplasmosis, Others(HAV,HBV, GBS, varicella, HIV), Rubella, Cytomegalovirus, Herpes
128
Rubella can cause
miscarriage, congenital abnormalities, and fetal death
129
when should mom get MMR vaccine
right after birth, and tell her not to get preg for at least 1 month
130
CMV can cause
microcephaly, eye, ear, dental defects, and MR
131
most comon viral STI
HPV
132
most common STI
chlamydia
133
most common cause of PID
chlamydia
134
contraception
intentional prevention of preg during sexual intercourse, can still get preg though d/t inconsistent or incorrect use of method
135
coitus interruptus
the pull out method, high failure rate and does not protect against STI
136
Fertility awareness method (FAM)
avoidance of intercorse during fertile periods (5-7 days in middle of cycle before and after ovulation), must have strict record keeping, doesn't work if cycle is irreg, no protection from STI
137
barrier methods
spermicides, condoms, diaphragm, cervical cap, contraceptive sponge
138
spermicides
reduce sperm mobility, not very effective if used alone, N9 is most common in US, freq use can inc risk of HIV?
139
condoms
provide physical barrier, protect from preg and STI
140
female condoms
lubricated vaginal sheath, only one size
141
diaphragm
cone shaped device placed up in vagina that forms barrier against sperm, should be fitted by OBGYN, refitted if weight change, associated with toxic shock syndrome
142
cervical cap
fits snugly around base of cervix, left in for 6hrs after sex, smaller than diaphragm and can be used for multiple episodes of sex
143
contraceptive sponge
sponge placed inside vagina that contains N9 spermicide, can be left in for 24hrs
144
hormonal methods of contraceptions
alter horms to prohibiting ovulation, many diff types. COG-combined estrogen-progestin contraceptives- the pill, take same time each day. Transdermal patch-same meds through a patch, vaginal ring-wear for 3 weeks, then take out for 1 week
145
advantages of OCP
convenient, dec blood loss, regulates menstrual cycle, dec dysmenorrhea and PMS, protects from ovarian cysts, dec risk for ectopic preg and certain cancers. Do NOT SMOKE with OCP
146
disadvantages of OCP
no prot from STI, contraindicated in women with Hx of thromboembolic issues, vascular disease, breast cancer, estrogen dependent tumors, preg, impaired liver function, lactating women, and smokers
147
side effects of OCP
bleeding irregularities, stroke, MI, thromboembolism, HTN, gallbladder disease, liver tumors, N, fluid retention, atrophic vaginitis, inc appetite, spotting
148
depo-provera
given IM during first 5 days of cycle and then every 11-13 wkks, does not impair lactation, no STI protection
149
emergency contraception
3 types available-high doses of oral progestins, high doses of COC's, insertion of copper IUD within 8 days of intercourse
150
IUDs
small t shaped device inserted into uterine cavity, copper one lasts 10 years, Mirena 5 years, offer long term preg prevention, no STI protection and increased risk of PID and uterine perforation, best for those in monogamous relationships
151
sterilization
surgical procedure to render one infertile-female-bilateral tubal ligation can be done through cutting tubes, burning, clipping, or inserting metal implants to seal tubes. Male-vasectomy-sealing, cutting, or tying vas deferens-takes a while to start working d/t sperm in ducts
152
does breast feeding provide contraception
yes for the short term
