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Nursing School > 🤰🏾- Exam 4 > Flashcards

🤰🏾- Exam 4 Flashcards

0
Q

Asphyxia

A

Insufficient oxygen and excess carbon dioxide in the blood and tissues

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1
Q

Low birth weight

A

Infants weighing 5lb 8oz (2500g) or less at birth and of ANY gestational age

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2
Q

Factors contributing to asphyxia

A

Preterm lungs with insufficient surfactant

Maternal (hypertension, infection, drug use)

Placental (placenta previa, abruptio placentae, postmaturity)

Fetal (cord problems, infection, premature birth, multifetal gestation)

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3
Q

Transient tachypnea of the newborn

Risk factors, manifestations

A

(Retained lung fluid)

Risk factors- cesarean, macrosomia, multiple gestation, excessive maternal sedation, prolonged or precipitous labor, make gender and maternal diabetes or asthma

Manifestations- develops within 6hrs of birth, grunting, retractions, nasal flaring and mild cyanosis

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4
Q

Infertility

A

Inability to conceive after 1 year of unprotected regular sexual intercourse

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5
Q

Primary vs secondary infertility

A

Primary- never conceived

Secondary- unable to conceive a second time

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6
Q

What are the 4 factors contributing to infertility in males

A

Abnormal sperm

Abnormal erections

Abnormal ejaculation

Abnormal seminal fluid

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7
Q

Causes of abnormal sperm

A
  • Hormonal
  • Chronic illness (mumps, cirrhosis, renal failure)
  • infection of the genital tract
  • varicocele or obstruction of the ducts that carry sperm to the penis
  • exposure to toxins (lead, pesticides)
  • antineoplastic drugs or radiation
  • excessive alcohol intake
  • use of illicit drugs (marijuana or cocaine)
  • elevated scrotal temp (fever, saunas, hot tubs, sitting prolonged periods)
  • immunologic factors
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8
Q

Causes of abnormal erections

A

Influenced by physical and psychological factors

Causes: CNS dysfunction , surgery, disorders affecting the spinal cord, PVD reduces a amount of blood entering the penis, antihypertensives or antidepressants may reduce erection or shorten duration

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9
Q

Retrograde ejaculation

Causes

A

Release of semen backward into the bladder

Causes: DM, neuro disorders, surgery that effects sympathetic nerves, antihypertensives and psychotropics, hypospadias, anxiety

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10
Q

Abnormal seminal fluid

A

Semen coagulates immediately after ejaculation but liquefies within 60 mins , permitting forward movement of sperm

Seminal fluid that remains thick traps the sperm , impeding their movement into the cervix

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11
Q

What are the 9 factors contributing to infertility in females

A

1 disorders of ovulation: altered secretion of the hormones

2 abnormalities of the Fallopian tube: tubal obstruction

3 abnormalities of the cervix: damaged or incompetent, abnormal mucous

4 abnormalities of the uterus: stenosis or congenital malformations

5 abnormalities of fetal chromosomes

6 endocrine abnormalities: inadequate progesterone secretion, diabetes or thyroid disorders

7 immunological factors: lupus, mother rejects embryo

8 environmental agents

9 infections of the reproductive tract

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12
Q

Gnrh, FSH , LH

A

Gonadotropin-releasing hormone: stimulates the pituitary to release FSH and LH

follicle-stimulating hormone: stimulates maturation of follicles in the ovary, mature follicles causes the ovary to secrete estrogen to thicken the endometrium

Luteinizing hormone: 24-36 hours BEFORE ovulation LH stimulates final maturation and release of one ovum from its follicle

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13
Q

Evaluation of infertility

A

History & reproductive history

Physical exam

Diagnostic tests: start with simple, least invasive, less expensive (males- semen analysis, females- ovulation monitoring, basal temp, cervical mucus)

Chromosomal analysis if repeated losses occur

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14
Q

What are the therapies used to facilitate pregnancy

A

Medications

Surgery

Insemination: sperm is placed into uterus

Egg donation: donor egg

Surrogate parenting

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15
Q

Clomiphene citrate

A

Clomid

Induces ovulation by increasing frequency of GnRH secretion from the hypothalamus, thus increasing FSH and LH release

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16
Q

Bromocriptine

A

Parlodel

Corrects excess prolactin secretion by anterior pituitary , improving LH and FSH secretion

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17
Q

hCG

A

Causes the corpus luteum to release progesterone to maintain the pregnancy

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18
Q

Ovarian hyperstimulation syndrome

A

Caused by too much hormone secretion

Ovarian enlargement with exudation if fluid and protein into the woman’s peritoneal and pleural cavities

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19
Q

In vitro fertilization

A

Maybe done to bypass blocked or absent Fallopian tubes

Removal of the ova and mix with sperm and return to the uterine cavity AFTER fertilization

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20
Q

Gamete intrafallopian transfer

A

Sperm and ova are injected into Fallopian tube

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21
Q

Zygote intrafallopian transfer

A

Aka tubal embryo transfer

Fertilized ova is placed in Fallopian tube

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22
Q

What type of contraceptives should be avoided in perimenopausal women and why

A

No oral contraceptives due to increased risk of stroke and coronary artery disease

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23
Q

Vasectomy

A

Male sterilization by cutting a section of the vas deferens, which carries spent from the testes to the penis

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24
ParaGard vs Mirena
ParaGard - (the copper T 380A) is effective for 10years Mirena - (levonorgestrel intrauterine System) is effective for 5 years **more effective that any other contraceptive**
25
Action of Mirena
Continuously releases progestin , which thickens cervical mucus and prevents transport of sperm into the endometrial cavity and Fallopian tubes
26
Side effects / contraindications / teaching for Mirena
Side effects- cramping and bleeding following insertion, menorrhagia, dysmenorrhea , irregular bleeding or spotting , amenorrhea Contraindications- ectopic hx, bleeding disorders, pelvic infections, abnormal uterus Teaching- side effects, check for presence of string every month
27
Implanon
A single rod implant, inserted SQ into the upper inner arm Releases progestin continuously to provide 3 years of contraception Acts to inhibit ovulation, thicken cervical mucus and makes endometrium unfavorable for implantation
28
Depo-provera
Injectable PROGESTIN available IM or SQ prevents ovulation for 15wks, injections should be scheduled every 13wks Side effects- menstrual irregularities, amenorrhea , weight gain, headaches, depression, hair loss nervousness, decreased libido, breast discomfort and decreased bone density *increases quantity of milk in lactating women*
29
Combination OCs
Contain estrogen and progestin Most common Cause thickening of cervical mucus , suppress production of LH and FSH Results in shorter, lighter periods
30
Progestin only pills
Minipill Taken daily with no hormone-free days Less effective in inhibiting ovulation but causes thickening of cervical mucus and makes endometrial lining unfavorable for implantation
31
Emergency contraceptive
Morning after pill (Plan b one-step, next choice, next choice one dose) Work by delaying or inhibiting ovulation, thickening cervical mucus and interfering with the function of the corpus luteum **take within 120hrs (5 days) of unprotected sex**
32
Oral contraceptives warning signs ACHES
A - abdominal pain (mesenteric or pelvic vein thrombosis) C- chest pain, dyspnea, hemoptysis, cough (PE or MI) H- severe headaches, weakness, numbness of extremities, HTN (stroke, migraine) E- eye problems/loss of vision (retinal vein thrombosis, stroke, migraine) S- severe leg pain or swelling in calf or thigh, heat, redness (DVT)
33
Contraceptive vaginal ring Common side effect
NuvaRing Soft, flexible vinyl ring containing estrogen and progestin inserted for 3 weeks and 1 week is ring-free COMMON SIDE EFFECT: headache 🤕 Prescription is needed
34
Transdermal contraceptive patch
Ortho evra Estrogen & progestin skin patch that suppresses ovulation and thickens cervical mucus New patch applied to a different site weekly for 3 weeks and removed for 1 week
35
Barrier methods Chemical vs mechanical
Prevent sperm from entering the cervix by destroying or creating a partition ; avoids use of systemic hormones Chemical- spermicides (cream or gel) , foams, tablets, films or suppositories Mechanical- male & female condoms, sponge, diaphragm and cervical cap
36
Cervical cap
Fem cap Placed over the cervix to prevent sperm from entering. With spermicide on each side Smaller than diaphragm size fitted by health care provider Can remain in place for 48hrs , don’t remove before 8hrs after sex
37
Diaphragm
Latex dome surrounded by a spring or coil Fitted by healthcare provider Pressure on the urethra May cause irritation and UTI Bigger than cervical cap Kept in place 6hrs before and after sex
38
Mittelschmerz
Pain on ovulation
39
Spinnbarkeit vs basal body temp
Spinnbarkeit- increased thinning and stretching 6 cm or more of cervical mucus with a raw egg white consistency indicates ovulation has occurred Basal body temp- slight elevation in temperature near the time of ovulation
40
How is breastfeeding an alternative method of contraception
Breastfeeding inhibits ovulation because suckling and prolactin interfere with secretion oh GnRH and LH
41
Toxic shock syndrome
Rate, potentially fatal condition caused by toxin-producing strains of staphylococcus aureus The toxin alters capillary permeability allowing intravascular fluid to leak from the blood vessels leading to hypovolemia, hypotension, and shock
42
Symptoms , treatment , prevention of toxic shock syndrome
Symptoms- sudden spiking fever (102’f) and flu-like symptoms (headache, sore throat, vomiting, diarrhea), hypotension, rash resembling sunburn, peeling skin on hands and feet, hypovolemia , petechiae Treatment- fluid replacement, vassopressors, antibiotics Prevention- wash hands, change tampons q4hrs, no cap or diaphragm during period
43
Vassopresors
Antihypotensive Raise low blood pressure
44
Ethics vs bioethics
Ethics- involves determining the best course of action in a certain situation Bioethics- application of ethics to health care
45
Deontologic model
Determines what is right by applying ethical principles and moral rules. Does not vary the solution according to individual situations Ex: life must be maintained at all costs and in all circumstances
46
Utilitarian model
Concerned more with the consequences of actions than the actions themselves Ex: the end justifies the means
47
Beneficence
Decision that produces greatest good or the least harm
48
Nonmaleficence
Avoid harming others
49
Respect for autonomy
People have the right to self-determination, this includes the right to respect, privacy and information necessary to make decisions based on their personal values and beliefs
50
Justice
All people should be treated equally and fairly regardless of disease or social or economic status
51
Accountability
Accept responsibility for actions
52
Confidentiality
Keep information private
53
Veracity
Tell the truth
54
Fidelity
Keep promises that can be kept
55
Mandated contraception
Used as a condition of probation allowing women accused of child abuse to avoid jail terms Interferes with constitutional rights
56
Fetal injury
If a mother’s actions cause injury to her fetus Maternal personal freedom vs fetal safety Fear of prosecution may lead mother to avoid prenatal care
57
What are the 4 elements of negligence
Duty- provide care as part of responsibility Breach of duty- violation of duty Damage- actual harm to the patient due to breach of duty Proximate cause- breach of duty must be proved to be the cause of harm
58
What are the 4 requirements of informed consent
Patients competence to consent Full disclosure of information needed Patients understanding of information Patients voluntary consent
59
Meconium aspiration syndrome Risk factors, manifestations, causes
Obstruction, chemical pneumonitis and air trapping caused by meconium in the lungs Risk factors- postterm, sga, decreased amniotic fluid/cord compression Manifestations- tachypnea, cyanosis, retractions, nasal flaring, grunting, rales , yellow-green stain on skin, nails and umbilical cord Causes- stress and asphyxia/hypoxia
60
ECMO
Oxygenates blood while bypassing the lungs, allowing the lungs to rest temporarily and recover
61
Vertical vs horizontal newborn infection
Vertical- acquired before or during birth from the mother Horizontal- occur after birth, acquired from hospital staff members or from family or visitors
62
Newborn sepsis Risk factors, management
Bacterial infection in the bloodstream Risk factors- premature, chorioamnionitis, prolonged RIM (>18hrs) Management- septic workup: (CBC-⬇️ neutrophils, platelets ⬆️ bands) CRP, treatment
63
Signs of sepsis in a newborn
Temperature instability Rash Tachypnea Respiratory distress (nasal flaring, retractions, grunting) Apnea Color changes Tachycardia Hypotension Decreased oral intake Vomiting/diarrhea Hypoglycemia or hyperglycemia Lethargy Jitteriness Irritability Full fontanel
64
Infants of diabetic mothers Risk factors (7)
* congenital anomalies * macrosomia - insulin acts as growth hormone * hypoglycemia- hyperglycemic mom gives baby too much glucose, baby makes too much insulin when born from mom causes hypo * RDS- increased levels of insulin block effect of cortisol on stimulation of lung maturation * polycythemia- response to chronic hypoxia in uteri * hypocalcemia- result of ⬇️ parathyroid hormone production * IUGR- mom with long term DM or HTN due to ⬇️ placental blood flow (vasoconstriction)
65
Polycythemia Causes, risk factors, support treatment, manifestations
Overproduction of RBC due to hypoxia Hemoglobin > 22 g/dL Hematocrit > 65% Manifestations- plethoric color, lethargy, irritability, poor tone and tremors Risk factors- at risk for jaundice due to excessive RBC break down after birth Supportive treatment- phototherapy and increased hydration
66
Normal range of hemoglobin and hematocrit
Hemoglobin- males: 14-18 , females: 13-16 Hematocrit- males: 40-54% , females: 36-48%
67
Hypocalcemia Signs, management, causes
Calcium level < 7 mg/dL Signs- irritability, jitteriness, poor feeding, muscle twitching (tetany), apnea, seizures Causes- IDM, asphyxia, prematurity, delayed nutrition, hyperparathyroidism, malabsorption, low Mg levels Management- feed, slow administration of IV Ca gluconate **must Monitor ❤️ rate**
68
NAS signs, management
Infants exposed to maternal drug use before birth demonstrate signs of withdrawal Signs- irritability, tremors, tachypnea, jittery, cry, poor suck/sleep pattern, excoriated skin, difficult to console, exaggerated Moro & rooting reflex Management- oral morphine, methadone, phenobarbital, buprenorphine and clonidine
69
Phenylketonuria
Genetic disorder that causes CNS injury from toxic levels of amino acid phenylalanine in blood Cause: deficiency of the liver enzyme phenylalanine hydrolase = increased phenylalanine in body Screening at atleast 24hrs of age Manifestations- severe cognitive impairment, musty odor of urine, seizures Diet- low phenylalanine formula and low protein
70
What is the importance of the third trimester Maturation , growth
Vital period of maturation- lung development, brain maturation, liver maturation Vital period of growth- body mass increases, fat stores increase, immune system, glycogen stores
71
Late preterm infants Common problems, assessments, discharge
34-36+ weeks Common problems- respiratory, hypothermia, hypoglycemia, jaundice, feeding problems, infection Assessments- should be done q30mins till 2hrs old, q4hrs till 24hrs old then once per shift , lactation consult Discharge- after 48hrs old, bilirubin levels checked, car seat test
72
Periodic breathing vs apneic spells Treatment
Periodic- cessation of breathing for 5-10secs with NO change in color or ❤️ rate Apneic- absence of breathing for 20secs or less if accompanied by cyanosis, pallor, bradycardia or hypotonia May require tactile stimulation Treatment- position, Monitor, suction, hydration to thin secretions
73
Preterm infants Assessments
< 37wks Assessments- respiratory (⬇️ surfactant), thermoregulation, fluid/electrolyte balance, skin, infection, pain, hypoglycemia (⬇️ feedings), immature liver, increases sepsis/decreased immunity
74
Brown fat vs white fat
Brown fat- generates heat White fat- adipose tissue , used for insulation in babies
75
Factors affecting the assessment of thermoregulation in preterm babies Interventions
* skin - thin * brown fat - decreased amount * extremities - extended increasing exposure to air Interventions- NTE neutral thermal environment
76
Kidney regulation in preterm infants
Ability of the kidneys to concentrate or dilute urine is poor, causing a fragile balance between dehydration and overhydration
77
Signs of dehydration in the newborn
Urine output < 1mg/kg/Hr Specific gravity < 1.01 Weight loss greater than expected Dry skin and mucous membranes Sunken anterior fontanel Poor tissue turgor Blood: elevated Na, protein and hematocrit Hypotension
78
Signs of overhydration in the newborn
Urine output > 3 ml/kg/hr Specific gravity > 1.002 Edema Weight gain greater than expected Bulging fontanels Blood: decreased Na, protein and hematocrit Moist breath sounds Difficulty breathing
79
Normal urine output for preterm baby
1-3 ml/kg/hr
80
List 5 risk factors contributing to infections in preterm
* skin * maternal exposure to infection * lack of adequate passive immunity from the transfer of IgG from mom during the 3rd trimester * prolonged hospitalization * procedures
81
pain in infants can cause
Hypoxia, hemorrhage, poor wound healing and poor growth
82
Signs of pain in infants
Increased or decreased ❤️ rate, RR, apnea Hypotension Color changes: red, dusky, pale Decreased O2 sat Whimpering, moaning Eyes squeezed shut Grimacing Furrowing or bulging of the brow
83
Interventions for increased stimulation from stressful environments
Schedule care Reduce stimuli Promote rest Promote motor development Individualize care & communicate
84
A baby arching it’s back is a sign of ?
Stress
85
Bronchopulmonary dysplasia
(Chronic lung disease) Damage to infants lungs requires prolonged dependence on supplemental oxygen Caused by high levels of O2 on vent Occurs most often in infants < 32wks and VLBW
86
Intraventricular hemorrhage
Bleeding into and around the ventricles of the brain Results from rupture of blood vessels in the germinal matrix, located around the ventricles of the brain 30% or infants weighing < 1500g develop intraventricular hemorrhage
87
Retinopathy of prematurity
Injury to blood vessels in the eye may result in visual impairment or blindness in preterm infants Occurs more often in preterm infants weighing < 1000g and less than 29wks gestation
88
Necrotizing enterocolitis
Inflammatory condition of the intestinal tract that may lead to cellular death of areas of intestinal mucosa Caused by formula feeding too early or increased too fast
89
Short bowel syndrome
Bowel that is shorter than normal causes inadequate absorption of fluids, electrolytes and nutrients
90
Postterm infants At risk for
> 42 weeks Risk for- hypoxia, hypoglycemia, injury, meconium aspiration, hypothermia, jaundice
91
Postmaturity syndrome
The fetus may not receive the appropriate amount of oxygen and nutrients and may be sga, resulting in hypoxia and malnourishment
92
Small-for-gestational-age At risk for, nursing considerations
Those who fall below the tenth percentile in size on growth charts At risk for- hypoglycemia, jaundice, hypothermia, meconium aspiration, polycythemia and low apgar scores Nursing considerations- asses for hypoglycemia especially in asymmetric growth, early and more frequent feeds, temp regulation and respiratory support, observe for jaundice in infants with polycythemia
93
Symmetric growth restriction vs asymmetric growth restriction
Symmetric- involves entire body. Weight, length, head circumference are below the 10th percentile but body is proportionate = issues early in pregnancy Asymmetric- head larger than rest of body. Normal length. Weight below 10th percentile. = issue in 3rd trimester (HTN or preeclampsia)
94
Large-for-gestational-age Causes, risk for
Those who are above the 90th percentile for gestational age on intrauterine growth charts Causes- DM, multipara, obese mom, ethnicity Risks- dystocia, hypoglycemia, hypothermia, jaundice, polycythemia
95
Macrosomia
Weigh more than 8lb 13oz to 9lb 15oz (4000-4500g)

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