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NUR 113 > Exam 3 FC's > Flashcards

Exam 3 FC's Flashcards

1
Q

4th trimester

A

postpartum or puerperium-about 6 weeks, till mom is back to normal

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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

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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

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4
Q

autolysis

A

self destruction of excess hypertrophied tissue. Helps uterus return to normal size

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5
Q

factors that slow involution

A

prolonged labor, anesthesia, pain meds, grand multiparity, full bladder, fragments left in uterus, Mg sulfate

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6
Q

mg sulfate

A

relaxes uterus and delays its shrinking after birth

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7
Q

factors that help involution

A

quick birth, ambulation, complete expulsion of placenta, breastfeeding-releases oxytocin

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8
Q

causes of death in postpartum women

A

1 is cardiovascular disease, then PP hemmorhage

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9
Q

what causes contractions

A

oxytocin released from pituitary

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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

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11
Q

exfoliation

A

healing and repairing of inside of uterus from placental tearing-takes about 16 days

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12
Q

comfort care for perineum with lacerations

A

warm water or sitz bath, ice packs, topical anestheitcs, AVOID CONSTIPATION, no sex,

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13
Q

horms PP

A

all horms decrease back to pre preg levels

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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

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15
Q

diastasis recti

A

seperation of ab muscles

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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,

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17
Q

blood loss during labor

A

norm for vag-300-400ml, c/s-800-1000ml

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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

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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

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20
Q

why does carpal tunnel go away after birth

A

b/c a dec in fluid relieves press on the nerve

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21
Q

why do PP women sweat more?

A

to get rid of retained fluids, may have shivering and tremors d/t fluid loss

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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

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23
Q

how do nurses prevent excess bleeding in PP mom?

A

maintenance of uterine tone, prevention of bladder distention

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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

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25
Q

phases of parental grief

A

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)

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26
Q

what culture is most likely to experience perinatal loss?

A

African Americans

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27
Q

attachment

A

process by which a parent comes to love and accept a child

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28
Q

bonding

A

period after birth where mom and dad have close contact with child, this helps later development of child

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29
Q

mutually

A

the infant’s behaviors and characteristics call forth a corresponding set of maternal characteristics. Ex baby smiles and mom gets excited

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30
Q

acquaintance

A

part of parental attachment where mom and baby are getting to know each other through touching, eye contact, and exploring

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31
Q

claiming process

A

the process of identifying the new baby

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32
Q

contact with baby

A

early contact is good for baby, extended contact helps parents bond with child

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33
Q

bio rhythmicity

A

fetus is in tune with mom’s HR in uterus, so after birth baby will recognize mom’s HR and tune in to it

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34
Q

reciprocity

A

baby moves or acts in response to certain things. Ex doorbell makes them cry

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35
Q

synchrony

A

the “fit” between the infant’s cues and the parents response

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36
Q

signs baby needs change of activity

A

turn head away, arch back, or cries.

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37
Q

engrossment

A

father’s absorption, preoccupation and interest in the infant

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38
Q

post partum hemorrhage (PPH)

A

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)

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39
Q

normal placental seperation

A

has detachment phase-where contractions cause shearing of placenta off uterus. Expulsion phase-where placenta is extruded from uterus into vagina

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40
Q

active management PP

A

MD’s now give pit before placenta comes out to shorten latent phase and dec PP bleeding

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41
Q

4 T’s of PPH

A

Tone-uterine atony (most common), Trauma (lacerations), Tissue (retained products), Thrombin (clots)

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42
Q

uterine atony

A

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

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43
Q

D&C vs D&E

A

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)

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44
Q

what can cause pressure type pain in PP woman

A

hematoma

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45
Q

nursing care for PPH pt

A

assess placenta for intactness, watch lochia closely, massage fundus, keep bladder empty, IV pit, or methergine, LR, NS or blood products

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46
Q

inversion of uterus

A

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

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47
Q

hematoma

A

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.

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48
Q

nursing care for hematoma

A

prevention and early detection are best, but if not caught check vitals, call MD

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49
Q

DIC

A

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

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50
Q

risk factors for clots in preg women

A

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

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51
Q

S/S of DVT

A

Homen’s sign, lower ext pain, redness, warmth, swelling, apprehension, cough, inc HR, inc Temp

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52
Q

S/S of PE

A

dyspnea, sweating, pallor, cyanosis, confusion, hypotension, cough, inc RR, HR and Temp, SOB, JVD, chest pain, fear, anxity, friction rub

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53
Q

Nursing care for pt with DVT

A

avoid prolonged use of stirrups, early ambulation, avoid crossing legs, bedrest, monitor for bleeding

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54
Q

parametritis

A

inf in conn tissue adjacent to uterus

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55
Q

localized puerperal

A

inf in uterus that can travel up, d/t MD not wearing gloves

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56
Q

risk factors for post partum dep

A

teenage moms, African Americans, didn’t graduate high school, Hx of dep

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57
Q

postpartum psychosis

A

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

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58
Q

first symptom of PP inf

A

fever greater than 38 for 2 days in a row

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59
Q

what is methergine used for?

A

for PP hemorrage, do not give if pt has high BP

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60
Q

chorioamnionitis

A

inf in amniotic fluid

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61
Q

amenorrhea

A

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
Q

CPPD

A

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
Q

dysmenorrhea

A

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
Q

PMS

A

premenstrual syndrome-sym occuring in luteal phase of menstrual cycle, include physical, psych and behavioral sym, must have ovaries to have PMS

65
Q

PDD

A

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
Q

endometriosis

A

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
Q

TAH

A

total abdominal hysterectomy-removal of uterus

68
Q

BSO

A

bilateral salpingo oophorectomy-removal of ovaries and fallopian tubes

69
Q

oligomenorrhea

A

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
Q

hypomenorrhea

A

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
Q

OCP

A

oral contraceptive pills

72
Q

metrorrhagia

A

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
Q

DUB

A

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
Q

menopause

A

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
Q

S/S of menopause

A

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
Q

dyspareunia

A

painful intercorse d/t smaller vagina, dryness, and thinned walls

77
Q

what two serious things can menopause cause?

A

osteoprosis and coronary heart disease

78
Q

osteoprosis

A

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
Q

risk factors for osteoprosis

A

inadequate Ca intake when younger, excesive caffeine intake, smoking, alcohol, steroids, hyperthyroidism

80
Q

how does too much soda affect bones

A

soda contains lots of phos which takes the place of Ca

81
Q

how does menopause affect the heart

A

estrogen dec LDL and inc HDL and has antiatherosclerotic affects on arteries, therefore when estrogen is dec body looses those benefits

82
Q

horm therapy for menopause

A

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
Q

how does estrogen prevent bone loss

A

it increases the calcitoning levels to prevent bone resorption and maintains bone density, therefore when estrogen dec then bones start to dec

84
Q

Types of STI

A

chlamydia, HPV, gonorrhea, Herpes type II, syphilis, HIV

85
Q

chlamydia

A

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
Q

how does chlamydia cause infertility

A

it makes the fallopian tubes slick so ovum does not stick to it

87
Q

chlamydia affects on preg

A

PROM, PTL, PP inf, infertility, PID, inc risk for ectopic preg. Baby can get conjunctivitis or pneumonia

88
Q

Tx for chlamydia

A

doxycycline, azithromycin, or amoxicillin

89
Q

Gonorrhea

A

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
Q

gonorrhea affects on preg

A

PROM, PTL, inc risk for inf, miscarriage, PP sepsis, conjunctivitis, IUGR

91
Q

Tx for gonorrhea

A

anti-infective- Rocefin (ceftriaxone) IM

92
Q

syphilis affects on preg

A

PTL, miscarriage, stillbirth, inf, anemia, CNS disorder

93
Q

Tx for syphilis

A

penicillin-if allergic then they must be desensitized to it. 2 injections given for 3 wks

94
Q

Pelvic inflam disease (PID)

A

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
Q

risk factors for PID

A

sexually active without condoms, recent IUD insertion, douching, vaginal child birth or nulliparity

96
Q

human papillomavirus (HPV)

A

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
Q

two most common manifestations of HPV

A

genital warts and cellular abnormalities on pap smear

98
Q

condylomata acuminata

A

cauliflower like genital wart from HPV

99
Q

classifications of cellular abnormalities

A

ASC-US, ASC-H, LSIL, HSIL

100
Q

ASC-US

A

Atypical squamous cells of undetermined significance- mild changes d/t to HPV.

101
Q

ASC-H

A

Atypical squamous cells high grade squamous intraepithelial lesion, are associated with precancerous abnormalities

102
Q

LSIL

A

low grade squamous intraepithelial lesion-usually transient, caused by HPV inf

103
Q

HSIL

A

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
Q

Tx for HPV

A

topical podofilox 0.5% gel, Imiquimod cream, cryotherapy, podophyllin resin, trichloroacetic acid (TCA), bichloroacetic acid(BCA)

105
Q

topical podofilox 0.5% gel

A

applied to warts BID for 3 days, then stop for 4 days and repeat if necessary. Don’t use if preg

106
Q

Imiquimod cream

A

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
Q

cryotherapy

A

freezed off wart, done by provider every 1-2 wks

108
Q

podophyllin resin with benzoin

A

apply a small amount to each wart and allow to airdry, done by provider

109
Q

Trichloracetic acid or bichloracetic acid

A

apply small amount to warts and allow to airdry, may be repeated weekly if needed. Done by provider

110
Q

Tx for HPV if preg

A

can use cryotherapy, TCA, BCA and surgical removal, may do C/S

111
Q

teaching for HPV

A

tell pts to watch for reocurrences, get regular pap smears , no sex until warts are gone, tell sex partners about warts

112
Q

herpes

A

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
Q

Herpes simplex II

A

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
Q

Herpes II affects on preg

A

inc rate of miscarriage and cervical cancer, neonatal herpes (potentially fatal or severely disabling)

115
Q

Tx for herpes II

A

zovirax (acyclovir) can be used in preg but risky. Valtrex-used in non preg. May do C/S

116
Q

HAV

A

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
Q

HBV

A

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
Q

HCV

A

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
Q

vaginitis

A

inf caused by microorganism (usually trichomoniasis), aka abnormal vag discharge

120
Q

bacterial vaginosis (BV)

A

inf changes pH of vag, can cause PTL. Tx is flagyl, do not breast feed while taking flagyl

121
Q

candidiasis

A

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
Q

risk factors for yeast inf

A

abx, diabetes, preg, obestity, diet high in sugar, steroids, immunocompromised

123
Q

trichomoniasis (Trich)

A

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
Q

Group B streptococcus (GBS)

A

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
Q

dystocia

A

obstructed labor or difficult labor

126
Q

effects of STIs on preg and fetus

A

preg-PROM, PTL, PP sepsis, dystocia, miscarriage. Fetal effects- preterm birth, pneumonia, systemic/congenital inf, stillbirth

127
Q

TORCH

A

titer tests for: Toxoplasmosis, Others(HAV,HBV, GBS, varicella, HIV), Rubella, Cytomegalovirus, Herpes

128
Q

Rubella can cause

A

miscarriage, congenital abnormalities, and fetal death

129
Q

when should mom get MMR vaccine

A

right after birth, and tell her not to get preg for at least 1 month

130
Q

CMV can cause

A

microcephaly, eye, ear, dental defects, and MR

131
Q

most comon viral STI

A

HPV

132
Q

most common STI

A

chlamydia

133
Q

most common cause of PID

A

chlamydia

134
Q

contraception

A

intentional prevention of preg during sexual intercourse, can still get preg though d/t inconsistent or incorrect use of method

135
Q

coitus interruptus

A

the pull out method, high failure rate and does not protect against STI

136
Q

Fertility awareness method (FAM)

A

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
Q

barrier methods

A

spermicides, condoms, diaphragm, cervical cap, contraceptive sponge

138
Q

spermicides

A

reduce sperm mobility, not very effective if used alone, N9 is most common in US, freq use can inc risk of HIV?

139
Q

condoms

A

provide physical barrier, protect from preg and STI

140
Q

female condoms

A

lubricated vaginal sheath, only one size

141
Q

diaphragm

A

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
Q

cervical cap

A

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
Q

contraceptive sponge

A

sponge placed inside vagina that contains N9 spermicide, can be left in for 24hrs

144
Q

hormonal methods of contraceptions

A

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
Q

advantages of OCP

A

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
Q

disadvantages of OCP

A

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
Q

side effects of OCP

A

bleeding irregularities, stroke, MI, thromboembolism, HTN, gallbladder disease, liver tumors, N, fluid retention, atrophic vaginitis, inc appetite, spotting

148
Q

depo-provera

A

given IM during first 5 days of cycle and then every 11-13 wkks, does not impair lactation, no STI protection

149
Q

emergency contraception

A

3 types available-high doses of oral progestins, high doses of COC’s, insertion of copper IUD within 8 days of intercourse

150
Q

IUDs

A

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
Q

sterilization

A

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
Q

does breast feeding provide contraception

A

yes for the short term

NUR 113 (4 decks)

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