Exam 3 Review Flashcards
(169 cards)
1
Q
Best predictor of sexual health?
A
Sexual and emotional well being
2
Q
Menopause can cause genitourinary atrophy
A
True
3
Q
Erectile dysfunction is linked to?
A
Diabetes
4
Q
Lab work for erectile dysfunction?
A
PSA
CBC
5
Q
Highest risk for sexual abuse?
A
Developmentally delayed
6
Q
Expedited partner therapy involves?
A
Treatment for each person
7
Q
Best STI protection?
A
Male condom
8
Q
Chlamydia infection site in men?
A
Urethra
9
Q
Herpes simplex virus 1 gives immunity to HSV 2
A
False
10
Q
Teratogen definition
A
Harmful agent
11
Q
Pregnancy duration
A
40 weeks
12
Q
Organogenesis occurs in which trimester?
A
First trimester
13
Q
Gravity definition in reproductive health?
A
Number of pregnancies
14
Q
Primary prevention includes:
A
Safe sex
15
Q
Folic acid prevents ?
A
Neural tube defects
16
Q
Copper IUD is an emergency contraception
A
True
17
Q
Chronic hypertension in pregnancy is before 20 weeks
A
True
18
Q
APGAR score assesses?
A
Appearance
Pulse
Grimace
Activity
Respirations
19
Q
Painless bright red vaginal bleeding is a hallmark symptom of what?
A
Placenta previa
20
Q
How many vessels are in the umbilical cord?
A
2 arteries and 1 vein
21
Q
Prolactin initiates breastmilk production
A
True
22
Q
A neonate startles when a loud sound is made. What reflex is this?
A
Moro reflex and is a normal finding
23
Q
What medical history finding should the nurse be concerned with when using carbopost tromethamine (Hemabate)?
A
Severe asthma
24
Q
Combined oral contraceptives and Methergine are safe for patients to take when they have hypertension
A
False
25
Gravity and parity describes what for a pregnant patient?
Times a woman is pregnant in her lifetime
Times a woman has deliver after 20/21 weeks gestation
26
What are the four stages of human sexual response model?
Excitement
Plateau
Orgasm
Resolution
27
Which Stage is Most Affected by a Myocardial Infarction and Antihypertensive Medications?
Excitement stage
These conditions can impair blood flow, lower libido, and contribute to sexual dysfunction.
28
What testing is done to evaluate a male patient experiencing erectile dysfunction?
PSA(Prostate specific antigen)
CBC
29
What are the 5 key areas to male sexual function?
erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction
30
List biological and psychological factors of sexual dysfunction:
Acute or chronic pain
Chronic fatigue
Anxiety
Depression
Cardiovascular disease
DM
Chronic respiratory conditions
31
List the four steps of the P.L.I.S.S.T. model and what each initial of P.L. I. S.S.T. stands for:
1. Permission to discuss sexuality issues (thoughts/fantasies)
2. Limited Information related to sexual health problems being experienced.
3. Specific Suggestions
4. Intensive Therapy- refer to a professional with advanced training.
32
What are the five P’s the nurse should ask about when using the P.L.I.S.S.T. model?
Partners- number and gender
Practices- safe sex
Protection (from infection)
Past history (of infection)
Prevention of pregnancy
33
Who should be tested for Chlamydia infections and when should they be retested?
All sexual active patients, those with high-risk sexual behaviors (history of STI), and victims of sexual assault.
They should be retested 3 months after initial treatment.
34
While caring for a patient who has tested positive for Chlamydia how would you explain
Expedited Partner Therapy?
This means that health care providers can provide meds or prescriptions to their patients with STIs to give to partners without actually examining the partner.
35
What as considered to be the best form of protection against STIs?
Male condom is considered to be the best form of protection (other than abstinence) against STIs
36
Until when do patient has to abstain from IC ?
Patient has to abstain from IC until patient and partner have completed meds/treatment.
37
List clinical manifestations of menopause:
No menses
-Vasomotor instability- hot flashes/night sweats
-Genitourinary atrophy- most likely cause of sexual dysfunction
-Hair changes
-Loss of skin elasticity
38
What can genital atrophy lead to?
It may lead to premature and unnecessary cessation of sexual activity.
Can be corrected with water soluble lubricants or estrogen cream.
39
What is the most common site for chlamydia infection in men?
The urethra
40
What is the most common site of chlamydia infection in women?
The cervix, causing cervicitis.
41
What test is used to diagnose and what is the treatment used for Chlamydia?
Nucleic acid amplification testing (NAAT) of endocervical/vaginal/urethral/urine/rectal/oropharyngeal swabs.
Treatment includes Azithromycin 1 gm single dose and Doxycycline 100 mg BID X 7. Patients need to abstain from intercourse for 7 days after treatment is completed.
42
What tests and treatments are used for gonorrhea?
Preferred test is NAAT, Gram stain is not very accurate for women, Culture of the urine, rectum or throat.
Treatment: IM Ceftriaxone, & Dual therapy with Azithromycin
43
What tests and treatments are used for syphilis (the great imitator)?
Blood test screen (VDRL or RPR). If screen is positive, confirmation with FTA-ABS or TP-PA. There can be false-positive and false-negative tests
Treatments consist of:
Penicillin G for all stages
If PCN allergic, use doxycycline or TCN
Aqueous procaine PCN G for neuro syphilis
44
Sequelae manifestation for gonorrhea:
May be asymptomatic.
Urethritis – male, Cervicitis – female,
NEONATE: Rectal, oropharyngeal or ophthalmic.
45
Sequelae manifestation for chlamydia:
Urethritis – male,
Cervicitis – female, rectal pain, Discharge, bleeding, dysuria,
MAY BE Asymptomatic.
46
Sequelae manifestations for syphilis:
Canker sores
Can be difficult to identify based on symptoms
47
What are the four stages of Syphilis? How do the stages present? What are complications of
Syphilis?
4 stages, takes weeks to years to go through all stages:
Primary: *** Highly infectious***, single or multiple chancres (painless lesion with rolled borders (10-90 days after exposure), lymphadenopathy, exudate and blood from chancre, lasts 3-6 weeks
Secondary: **highly infectious**, a few weeks after primary chancre heals, flu like symptoms (malaise, fever, sore throat, headaches, fatigue, arthralgia, generalized adenopathy), mucous patches in mouth, tongue, cervix. Symmetric, nonpruritic rash on trunk, palms, soles, condyloma lata (moist weeping papules in anogenital area, weight loss, alopecia, this stage lasts 1-2 years
Latent: first year infectious, > one year noninfectious, no signs or symptoms, diagnosis based on treponemal antibody test, this stage lasts throughout life or progression to late stage
Late: noninfectious, 1-20 years after infection, gummas (chronic, destructive lesions on any organ of body esp. skin, bone, liver, mucous membrane), cardiovascular by causing aneurysms, heart valve insufficiency, heart failure, aortitis, Neuro syphilis, paresis : muscle weakness from neuro damage: personality changes from minor to psychotic, tremors, physical and mental deterioration, Tabes dorsalis (ataxia, areflexia, paresthesias, lightning pains, damaged joints). This stage is chronic without treatment, fatal
48
Once a person/patient tests positive for Syphilis can they remain positive after an indefinite period even with successful treatment?
Yes, once a person has tested positive for syphilis, these findings may remain positive for an indefinite period in spite of successful treatment.
49
What are the symptoms of trichomoniasis?
men have burning with urination or ejaculation or urethral discharge
Women may have painful urination, vaginal itching, painful intercourse, bleeding after IC, yellow-green discharge with a foul odor
50
What are teratogens and examples?
A teratogen is any agent (drug, infection, toxin) or factor that induces or increases incidence of abnormal prenatal development.
51
Know the components of preconception care
Preconception care consists of health promotion, risk screening, and implementation of interventions before pregnancy with goal of modifying risk factors that could negatively impact a pregnancy.
Includes:
Routine physical exam
Health screening
52
dietary needs in pregnancy and be able to teach patients/families about specific food sources.
Food sources of folic acid: Leafy green vegetables, such as spinach
Citrus fruits, such as orange juice
Beans
Breads
Cereals
Rice
Pastas
53
Be able to advise a patient about the risks, uses, and benefits of all non-hormonal methods of contraception:
Abstinence:
-Advantages: safe, free, available to all, 100% effective, encourages communication
-Disadvantage: Both participants must practice self control
Coitus interruptus: male to withdraw penis from vagina prior to ejaculation. Requires self control.
-Advantages: works at any time of the menstrual cycle, free
-Disadvantages: least reliable method; 80% effective with typical use, there may be pre ejaculatory fluid with sperm
Fertility Awareness Methods:
Symptoms of ovulation: increased libido, midcycle spotting, mittelschmerz, pelvic fullness, vulvar fullness
-Advantages: free, safe, acceptable to some religions, increases awareness of woman’s body, encourages couple communication, can be used to prevent of plan a pregnancy
-Disadvantages: Requires extensive initial counseling and education, may interfere with sexual spontaneity, may be difficult or impossible for those with irregular menstrual cycles, no protection against STI, less effective with actual use
Basal body temp: if no elevation in temp, probably did not ovulate
54
What is Gravity and Parity
G (gravity) is the # of pregnancies in a woman’s lifetime.
P (parity) is the # of births >20 weeks (viable and nonviable)
TPAL- a more descriptive subset of parity
T- # of term births (>37 weeks)
P- # of preterm births (<37 weeks)
A- # of abortions ( elective, spontaneous, or therapeutic <20 weeks)
L- # of living children
55
What are the populations at highest risk for problems with reproduction?
Impoverished populations- don’t have the money for prenatal care and nutritious food.
Adolescents- concerns: impaired nutrition, anemia, infections. Many adolescents don’t want to disclose pregnancy.
56
What is infertility?
The inability to conceive after 1 year of unprotected sex.
57
What are the 4 goals when providing care for a couple with infertility issues?
Provide the couple with accurate information
Assist in identifying the cause of infertility
Provide emotional support
Guide and educate about forms of treatment
58
What are the factors associated with infertility?
For male and female, hx: occupation, menstrual hx, childhood infectious diseases (mumps for male) Sexual hx: intercourse frequency, sti
Substance use: ETOH, tobacco, heroin and methadone.
Female: ovarian, tubal and peritoneal, uterine (abnormal uterine contours or scar tissue), vaginal-cervical factors.
Male: hormonal, testicular, factors associated with sperm transport, and idiopathic male infertility.
59
components/order of evaluation of the couple with infertility.
Female assessment: detection of ovulation, hormone analysis.
Male assessment: semen analysis, hormone analysis, scrotal ultrasound (from less invasive to most invasive)
The male evaluation is much less involved and a semen analysis should be done first
60
What is the plan of care and implementation for infertility?
Psychosocial considerations
Non medical treatments - herbal alternative methods, nutritional and dietary changes, exercise, stress management.
Medical therapy- ovarian stimulation medication
Surgical therapies- assisted reproductive therapies (ART)
Intrauterine insemination- places sperm in the uterus.
61
Signs of pregnancy and examples:
Presumptive signs: subjective signs , they think they’re pregnant.
Probable signs: objective physiologic and anatomic changes that make the provider think the patient might be pregnant.
Positive signs- Objective signs that can only be noted by examiner and attributed to the fetus via auscultation of the fetal heart rate at 10-12 weeks by Doppler, positive pregnancy test.
62
What is the formula for Naegele’s Rule to calculate estimated date of delivery (EDD)?
LMP -3months +7 days = EDD
63
What are the weight guidelines in pregnancy?
BMI
Below 18.5 = 28-40 pounds
18.5 - 24.9 = 25-35 pounds
Above 25 = 15-25 pounds
64
What is the most accurate way of calculating approximate due date during the 1st trimester?
Early ultrasound ( first trimester) is the most accurate way of calculating approximate due date.
65
Why is an ultrasound important during the second trimester?
To confirm established due date (18 weeks)
66
Medical conditions that complicate the antepartum phase and possible Sequelae:
Cardiovascular system: decrease in peripheral vascular resistance causing decrease in blood pressure. 40-45% increase in blood volume causing hypervolemia (physiologic anemia of pregnancy) Increase in RBC count by 30% causing physiological anemia of pregnancy.
67
What are the second and third trimester danger signs to watch for?
Gush of Fluid from vagina before 37 weeks, Vaginal Bleeding, Changes in fetal activity, Severe headaches, Dysuria.
68
What is preterm labor?
The onset of labor before 37 weeks. The patient will have cramping/labor contractions and the cervix will change
69
What are the problems with a set of overlapping factors of influence of preterm labor?
20-25% of preterm births are intentional and implicated for problems ie HTN, preeclampsia, hemorrhage, IUGR where early delivery would improve either maternal or fetal status.
70
What are tocolytic drugs used for in the management of preterm labor?
They are used to suppress uterine contractions. . Used to delay delivery for several days (optimal 72 hours) not for long-term use. The 72 hours gives time to give steroids to improve fetal lung maturity.
71
What are the tocolytics used?
Indomethacin
Nifedipine-inhibits contractions by stopping calcium from entering smooth muscles.
Magnesium sulfate-relaxes smooth muscle of uterus
Terbutaline
72
What is PPROM?
Is rupture of membranes , 37 weeks.
Premature rupture of membranes is rupture of the membranes before onset of labor but at term. Prolonged rupture of membranes is greater than 24 hours.
Previable ROM is before 23-24 weeks, preterm ROM is 24-32 weeks, preterm ROM is 31-36 weeks
Nursing actions: Assess FHR and contractions, assess for signs of infection, monitor for labor and fetal compromise, antenatal testing
73
What are the risks for pre-gestational diabetes for women?
hypoglycemia and hyperglycemia, DKA, HTN and preeclampsia, metabolic dusturbances, preterm labor, spontaneous abortion, polyhydramnios or oligohydramnios, c section, exacerbation of chronic diabetes related conditions, infection, induction of labor.
74
What are the risks for pre-gestational diabetes for newborn?
congenital defects related to maternal hyperglycemia during organogenesis, macrosomia, hypoglycemia, hypocalcemia and hypomagnesemia, IUGR, asphyxia related to fetal hyperglycemia and hyperinsulinemia, respiratory distress syndrome, polycythemia, hyperbilirubinemia, prematurity, cardiomyopathy,birth injury, stillbirth in poorly controlled DM.
75
What are the hypertensive disorders in pregnancy?
Educate maternal patients to report blurred vision and headaches to their providers.***
Chronic hypertension: HTN (140/90) before conception or before the 20th week of gestation that persists after 12 weeks postpartum, may put woman at risk for developing preeclampsia.
Preeclampsia, eclampsia: systemic disease with HTN accompanied by proteinuria after the 20th week of gestation. Eclampsia is the onset of seizures.
Preeclampsia superimposed on chronic HTN: woman with HTN who develops new onset proteinuria, proteinuria before the 20th-week gestation.
Gestational hypertension: Develops after 20 weeks no proteinuria.
76
What is the HELLP syndrome?
Hemolysis, Elevated Liver enzymes, and Low Platelets ( is preeclampsia with liver involvement)
HELLP lab values: platelets will be <100,000/mm3, AST(Aspartate Aminotransferase) >70, ALT (Alanine Transaminase) 50, bilirubin (indirect) >1.2
LDH > 600. (lactate dehydrogenase enzyme found in muscle, brain, liver, kidneys and rbc; released with cell damage)***
77
What are the signs for severe preeclampsia?
Headache
Confusion
History of convulsions
Respiratory symptoms (dyspnea, chest pain, cough)
Visual disturbances/blindness
Nausea/vomiting
Right upper quadrant pain
Decreased urine output
78
What is the hallmark of placenta previa?
Is the sudden onset of painless vaginal bleeding.
79
What is the leading cause of death due to an ectopic pregnancy?
Hemorrhage (bleeding) is the number 1 cause of death.
80
What are the risks for the fetus in a patient that has uncontrolled asthma?
Hypoxia leading to IUGR, preterm birth, low birth weight
81
What are the factors affecting labor (5 Ps)?
Powers (the contractions)
Passage (the pelvis)
Passenger (the fetus)
Psyche (the response of woman)
Position (maternal postures and physical positions to facilitate labor)
82
What is the difference between true and false labor?
True labor:
- regular contractions that increase in frequency and intensity.
- change in cervix
- causing effacement and dilation
False labor:
- contractions but no change in cervix
- activity doesn’t change pattern
- hydration or sedation slows/stops ctxs
83
What are the stages of labor?
Stage 1- has 3 phases
Stage 2, 3 and 4.
84
What are the 3 different phases in stage 1 of labor?
First stage begins with the onset of true labor and ends with complete cervical dilation and complete effacement
-latent: patient is talkative and eager, 6 hours primip/4 hours multip (0-3 cm)
-active: patient feels helpless, anxiety and restlessness, 3 hours primip, 2 hours multip (4-7 cm)
-transition: Complete dilation, tired, restless, irritable, n/v, urge to push, rectal pressure feeling need to have bowel movement, 20-40 minutes (8-10 cm)
85
What happens during stage 2 of labor?
Starts with complete cervical dilation and ends with the birth of the baby.
86
What is stage 3 of labor?
Begins immediately after delivery of the fetus and involves separation and expulsion of the placenta and membranes.
87
What is stage 4 of labor?
The fourth stage begins after the delivery of the placenta and ends within 4 hours. Time for mother to bond with baby, skin to skin can help baby if in distress.
88
What is the nursing care provided for women receiving an epidural?
Assess for hypotension and respiratory distress. Up to 40% of women may experience hypotension.
89
Latent phase of labor is indicated by
Cervix 0–3 cm dilated with contractions every 5–10 min, of mild intensity, lasting 30–45 sec
90
Active phase of labor is indicated by
Average dilation 1.2 cm/hr, dilation progresses 4–7 cm
91
Transition phase of labor is indicated by
Dilation from 8 to 10 cm, contractions intense, q 1–2 min lasting 60–90 sec
92
What is dystocia and how it complicates labor?
is a difficult or abnormal labor related to the 5 powers of labor. Atypical uterine contraction patterns prevent the normal process of labor and its progression.
There will be a lack of progress in dilation, effacement, or fetal descent during labor. A hypotonic uterus is indentable even at the peak of the contraction.
93
What is the bishop score?
Bishop score measures: cervical dilation, cervical effacement, cervical consistency, cervical position, and station of the presenting part (fetus).
94
what does it mean to have an operative vaginal delivery and what risks the patient may have?
It is assisted delivery by vacuum or forceps.
Risks: laceration of the cervix, laceration of the vagina and perineum, injury to the bladder, facial nerve palsy of the neonate, facial bruising of the neonate
95
Labor that lasts less than 3 hours from onset of labor to birth is categorized as
Precipitous labor
96
Fetal dystocia may be caused by
Excessive fetal size or malpresentation
97
Common interventions associated with induction include:
Intravenous (IV) fluids
Bed rest
Continuous fetal monitoring
Increase pain medication use and epidural anesthesia
98
What are the medical reasons for a Cesarian section?
-Dystocia- Ineffective UC leading to prolonged first stage of labor
-Placental abnormalities
-Category II and III FHR pattern (such as late decelerations and no variability on fetal strip)
-Maternal factors: cardiac disease, HTN, preeclampsia
-Multiple gestation
99
What is the immediate postoperative care for a c-section?
Need to assess the level of anesthesia.
100
What is shoulder dystocia?
It refers to the difficulty encountered during delivery of the shoulders after the birth of the head.
101
What is the postpartum focused assessment?
BUBBLE
Breast
Uterus (fundal height, uterine placement, and consistency)
Bowel (and GI function)
Bladder function
Lochia (color, odor, consistency, and amount, ( COCA))
Episiotomy (REEDA (redness, edema, ecchymosis, discharge, approximation of edges))
Vital signs, including pain
Patient needs
102
What are afterpains and nursing interventions?
Multiparous women or women who are breastfeeding may have afterpains during the first postpartum days. Afterpains are moderate to severe cramping pains of the uterus working harder to stay contracted and/or related to the increase of oxytocin that is from the infant suckling.
103
When is the greatest risk for PP hemorrhage?
The risk for PP hemorrhage is greatest within the first hour following delivery.
104
When does primary PP hemorrhage occur?
Primary postpartum hemorrhage (early) occurs during the first 24 hours.
105
When does secondary PP hemorrhage occur?
Secondary (late) pp hemorrhage is most prevalent during the first 6-14 days following birth.
106
What are the PP expected findings related to the uterus?
After birth the fundus is palpated midway between the umbilicus and symphysis pubis and is firm and midline. Within 12 hours after birth of the placenta, the fundus is at the level of the umbilicus or 1 cm above the umbilicus. 24 hours after the fundus is 1 cm below the umbilicus. The uterus descends 1 cm a day. At day 14 the fundus has descended into the pelvis and is not palpable.
107
When is lochia assessed?
Each time the uterus is assessed.
108
What precaution are you supposed to take when assessing the PP uterus?
support of the lower uterine segment to prevent the risk of uterine inversion.
109
What is the location of the Fundus at day one?
Day 1 it is 1 cm or finger breadth below the umbilicus
110
How is lochia assessed?
Lochia is assessed as scant, light, moderate, or heavy (scant is less than 1 inch on the pad, light is less than 4 inches, moderate is less than 6 inches, heavy is when the pad is saturated within 1 hour.
111
Your patient is a 22-year-old woman who gave birth to her first child 12 hours ago. You would expect her fundus to be located ______.
At the level of the umbilicus
112
How to treat a plugged milk duct?
To treat plugged milk duct, frequent feedings, changing feeding positions, apply warm compresses, massage the breasts prior to feeding. Failure to resolve this may lead to mastitis.
113
Only the women who are lactating will experience primary engorgement.
False
114
Signs of bladder distention during the first 12 hours postpartum include?
Uterus displaced to right of umbilicus
Increased lochia
115
What is PP hemorrhage?
PP hemorrhage is a blood loss greater than 500ml following vaginal delivery and 1000ml following cesarean delivery with a 10% drop in hemoglobin and/or hematocrit
116
What are the main causes of PP hemorrhage?
The primary causes of PPH are uterine atony, retained placental fragments, and lower genital track lacerations.
117
What is uterine atony?
Uterine atony is a decreased tone of the uterine muscle and is the major cause of primary PPH
118
What are the assessment findings of uterine atony?
boggy fundus, saturation of pad in 15 minutes, bleeding is slow and steady or sudden and massive, blood clots may be present, pale color and clammy skin, anxiety and confusion, tachycardia, hypotension.
119
What is the medical management for uterine atony?
bimanual compression of the uterus
120
What could be the cause of a firm fundus with too much bleeding?
If fundus if firm but patient is bleeding too much, probably a vaginal or cervical laceration
Lacerations are the second most common cause of primary PPH, can happen during childbirth. Common sites are the cervix, vagina, labia, and perineum
121
What is the medical management for lacerations?
visual inspection of cervix, vagina, perineum and labia, surgical repair of laceration.
122
How do hematomas happen?
Hematomas occur when the blood collects within the connective tissues of the vagina or perineal areas related to a vessel that ruptures and continues to bleed
123
How do hematomas in the perineal are present?
hematomas in the perineal area present with swelling, discoloration, and tenderness, hematomas with an accumulation of 200-500mo of blood can become large enough to displace the uterus and cause uterine atony which can then increase the degree of blood loss.
124
How to reduce the risk for hematomas?
Apply ice to the perineum for the first 24 hours to reduce risk of hematoma.
125
What is subinvolution of the uterus?
Subinvolution of the uterus is a term used when the uterus does not decrease in size and does not descend into the pelvis. This usually occurs later in the postpartum period.
126
What is the primary cause of secondary PP hemorrhage?
Retained placental tissue is the primary cause of secondary postpartum hemorrhage.
It is also due to subinvolution or hematomas.
127
What are the assessment findings of retained placental tissue?
profuse bleeding that suddenly occurs after the first postpartum week, subinvolution of the uterus, elevated temperature and uterine tenderness if metritis is present, pale skin color, tachycardia, hypotension
128
What is disseminated intravascular coagulation (DIC)?
DIC is a syndrome in which the coagulation pathways are hyperstimulated. When this occurs, the woman’s body breaks down blood clots faster than it can form them, thus quickly depleting the body of clotting factors and leading to hemorrhage and death
129
What are the risk factors for DIC?
placental abruption (this is the primary cause of DIC), HELLP syndrome *(*which is a severe form of preeclampsia), amniotic fluid embolism
130
What are the risk factors for infections (metritis)?
cesarean birth,*** prolonged ROM, prolonged labor, internal fetal and uterine monitoring, meconium stained fluid, multiple cervical exams in labor, obesity
131
What are the assessment findings for infection?
temperature greater than 100.4, lower abdominal pain, uterine tenderness, tachycardia, subinvolution, malaise, lochia heavy and foul smelling.
132
What is cystitis infection?
Cystitis is an infection of the bladder. It is common in the postpartum period. It is easily treated but if left untreated, it could become pyelonephritis.
133
What are the risk factors for cystitis infection?
epidural anesthesia, overdistended bladder, foley catheter inserted during labor, neonatal macrosomia, operative vaginal deliveries, intrapartal vaginal exams.
134
What are the nursing interventions in the patient with postpartum mastitis?
risk reduction by explaining importance of washing her hands before feeding to decrease spread of bacteria, proper handwashing by hospital personnel, methods to decrease nipple irritation and tissue breakdown such as correct infant latch and removal, air drying nipples, palpate and inspect breasts for signs of mastitis, antibiotics per orders, analgesia per orders, apply warm compresses, **continue to empty each breast by breastfeeding or to massage and express milk, explain that this is common.
135
What are the assessment findings for PP depression?
sleep (such as insomnia) and appetite disturbances, **fatigue greater than expected for caring for a newborn, despondency, **uncontrolled crying, anxiety, fear and or panic, inability to concentrate, feeling of guilt, inadequacy and or worthlessness, inability to care for self and baby, decreased affectionate contact with the infant
136
What is PP depression?
PPD is a mood disorder characterized by severe depression that occurs within the first 6-12 months postpartum.
137
What are the nursing interventions for PP depression?
assess for risk factors, monitor mother infant interactions closely for women at risk for PPD, teach the woman and her partner signs of PPD, be supportive and encouraging, provide the woman with information regarding PP support groups and other community resources
138
What is the difference between PP blues and PP depression?
PP blues:
Symptoms disappear without medical intervention
Occurs within the first 2 weeks PP
Able to safely care for self and baby
PP depression:
Requires psychiatric intervention
Occurs within the first 12 months PP
Unable to safely care for self and/or baby
139
What is PP Psychosis?
PPP is a variant of bipolar disorder and is the most serious form of postpartum mood disorders. It is rare. Onset of symptoms can be as early as the third PP day
140
Why do women with PP psychosis require immediate hospitalization and evaluation?
Women with PPP require immediate hospitalization and evaluation as they are at risk for injuring themselves or their infants
141
What are nursing actions for patients with PP Psychosis?
assess for risk factors, **monitor infant care, educate women who are at risk. Early detection will reduce the extent of the problem
142
A woman is 1 hour post delivery. The nurse notes that the woman’s fundus is firm, midline, and at the umbilicus. Her lochia is heavy and she has saturated her pads in less than 15 minutes. Based on these assessment findings, the woman is most likely experiencing a primary postpartum hemorrhage related to _________.
Laceration of the vaginal or cervical areas
143
The first nursing action for a woman experiencing a PPH related to uterine atony when the uterus is midline is
Fundal massage
144
Women who have mastitis cannot breastfeed from the affected breast until 24 hours after starting antibiotic therapy.
False
145
When does transition to extrauterine life begins?
This transition to extrauterine life begins at birth when the umbilical cord is clamped, and the neonate takes his/her first breath
146
What are the focus of nursing care for a neonate?
maintaining body heat, maintaining respiratory fx, decreasing risk of infection, assisting parents in providing appropriate nutrition and hydration, and assisting parents in learning to care for their newborn.
147
What are the most critical changes in a neonate?
The most critical changes are in the respiratory and cardiovascular systems.
148
What are 2 factors that negatively affect transition to extrauterine respirations?
decreased surfactant levels related to immature lungs, and persistent hypoxemia and acidosis that leads to constriction of the pulmonary arteries.
149
What are signs of respiratory distress in a neonate?
cyanosis, an abnormal respiratory pattern such as apnea and tachypnea, retractions of the chest wall, grunting, flaring of the nostrils, hypotonia.
150
What are the factors that negatively affect thermoregulation?
Factors that negatively affect thermoregulation are decreased subcutaneous fat, decreased BAT in preterm neonates, large body surface, loss of body heat from convection, radiation, conduction and or evaporation.
151
What is evaporation?
loss of heat that occurs when water on the skin is converted to vapors such as during bathing or directly after birth.
152
What is conduction?
transfer of heat to cooler surface by direct skin contact such as cold hands of caregivers or cold equipment.
153
What is convection?
loss of heat from the neonate’s warm body surface to cooler air currents such as air conditioners or oxygen masks.
154
What is radiation?
transfer of heat from the neonate to cooler objects that are not in direct contact with neonate, such as cold walls or cold equipment.
155
What are the risk factors of cold stress in a neonatal?
prematurity, SGA, hypoglycemia, prolonged resuscitation efforts, sepsis, neurological, endocrine or cardiorespiratory problems.
156
What is the best way to reduce heat loss due to radiation and conduction in a neonate?
Skin to skin contact with the mother with a warm blanket over the mother and neonate decreases heat loss due to radiation and conduction
157
When is breastfeeding initiated?
Initiate breast feeding in initial period of activity.
158
What is the Brazelton Neonatal Behavioral Assessment Scale used for?
used to assess the neonate’s neurobehavioral system
159
What are the 5 areas that are assessed using the Neonatal Abstinence Syndrome (NAS) scoring system?
CNS, metabolic, vasomotor, respiratory, and gastrointestinal findings
160
What is the normal temperature of a neonate?
36.5 to 37.2 C (97.7 to 99 F)
161
What is the normal respiratory rate of a neonate?
30 to 60 breaths per minute, slightly irregular
162
What is the normal pulse of a neonate?
120-160 BPM, may increase to 180 when crying and may be as low as 100 when sleeping. Murmurs may be heard; most are not pathological and disappear by 6 months.
163
What is the normal glucose levels in a neonate?
40-60 mg/dL
164
What is the law in NM regarding infants riding rear facing?
NM law states that infants under the age of 1 must ride in a rear-facing child seat.
165
What are the S/S of hypoglycemia?
Jitteriness, hypotonia, irritability, apnea, lethargy, and temperature instability.
166
What are the S/S of hypothermia?
Axillary temperature at or below 36.5C or 97.7 F, cool skin, lethargy, pallor, tachypnea, grunting, hypoglycemia, hypotonia, jitteriness, weak suck.
167
Which vitamin decreases in a neonate after birth?
Neonate experiences a decrease in vit K and is at risk for delayed clotting and for hemorrhage. Vit k is synthesized in the intestinal flora which is absent in the newborn, this flora develops with the first feeding.
168
How is the Ballard Maturational Score calculated?
It is calculated by assessing the physical and neuromuscular maturity of the neonate.
169
If the umbilical cord prolapses during labor, the first thing the nurse should do is:
Apply manual pressure to the presenting part to relieve pressure on the cord.
