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Tests various > 🤰🏾- Exam 4 > Flashcards

🤰🏾- Exam 4 Flashcards

1
Q

Asphyxia

A

Insufficient oxygen and excess carbon dioxide in the blood and tissues

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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
Q

ParaGard vs Mirena

A

ParaGard - (the copper T 380A) is effective for 10years

Mirena - (levonorgestrel intrauterine System) is effective for 5 years
more effective that any other contraceptive

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25
Q

Action of Mirena

A

Continuously releases progestin , which thickens cervical mucus and prevents transport of sperm into the endometrial cavity and Fallopian tubes

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26
Q

Side effects / contraindications / teaching for Mirena

A

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

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27
Q

Implanon

A

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

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28
Q

Depo-provera

A

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

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29
Q

Combination OCs

A

Contain estrogen and progestin

Most common

Cause thickening of cervical mucus , suppress production of LH and FSH

Results in shorter, lighter periods

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30
Q

Progestin only pills

A

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

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31
Q

Emergency contraceptive

A

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

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32
Q

Oral contraceptives warning signs ACHES

A

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)

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33
Q

Contraceptive vaginal ring

Common side effect

A

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

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34
Q

Transdermal contraceptive patch

A

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

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35
Q

Barrier methods

Chemical vs mechanical

A

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

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36
Q

Cervical cap

A

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

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37
Q

Diaphragm

A

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

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38
Q

Mittelschmerz

A

Pain on ovulation

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39
Q

Spinnbarkeit vs basal body temp

A

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
Q

How is breastfeeding an alternative method of contraception

A

Breastfeeding inhibits ovulation because suckling and prolactin interfere with secretion oh GnRH and LH

41
Q

Toxic shock syndrome

A

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
Q

Symptoms , treatment , prevention of toxic shock syndrome

A

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
Q

Vassopresors

A

Antihypotensive

Raise low blood pressure

44
Q

Ethics vs bioethics

A

Ethics- involves determining the best course of action in a certain situation

Bioethics- application of ethics to health care

45
Q

Deontologic model

A

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
Q

Utilitarian model

A

Concerned more with the consequences of actions than the actions themselves

Ex: the end justifies the means

47
Q

Beneficence

A

Decision that produces greatest good or the least harm

48
Q

Nonmaleficence

A

Avoid harming others

49
Q

Respect for autonomy

A

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
Q

Justice

A

All people should be treated equally and fairly regardless of disease or social or economic status

51
Q

Accountability

A

Accept responsibility for actions

52
Q

Confidentiality

A

Keep information private

53
Q

Veracity

A

Tell the truth

54
Q

Fidelity

A

Keep promises that can be kept

55
Q

Mandated contraception

A

Used as a condition of probation allowing women accused of child abuse to avoid jail terms

Interferes with constitutional rights

56
Q

Fetal injury

A

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
Q

What are the 4 elements of negligence

A

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
Q

What are the 4 requirements of informed consent

A

Patients competence to consent

Full disclosure of information needed

Patients understanding of information

Patients voluntary consent

59
Q

Meconium aspiration syndrome

Risk factors, manifestations, causes

A

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
Q

ECMO

A

Oxygenates blood while bypassing the lungs, allowing the lungs to rest temporarily and recover

61
Q

Vertical vs horizontal newborn infection

A

Vertical- acquired before or during birth from the mother

Horizontal- occur after birth, acquired from hospital staff members or from family or visitors

62
Q

Newborn sepsis

Risk factors, management

A

Bacterial infection in the bloodstream

Risk factors- premature, chorioamnionitis, prolonged RIM (>18hrs)

Management- septic workup: (CBC-⬇️ neutrophils, platelets ⬆️ bands) CRP, treatment

63
Q

Signs of sepsis in a newborn

A

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
Q

Infants of diabetic mothers

Risk factors (7)

A
  • 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
Q

Polycythemia

Causes, risk factors, support treatment, manifestations

A

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
Q

Normal range of hemoglobin and hematocrit

A

Hemoglobin- males: 14-18 , females: 13-16

Hematocrit- males: 40-54% , females: 36-48%

67
Q

Hypocalcemia

Signs, management, causes

A

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
Q

NAS

signs, management

A

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
Q

Phenylketonuria

A

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
Q

What is the importance of the third trimester

Maturation , growth

A

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
Q

Late preterm infants

Common problems, assessments, discharge

A

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
Q

Periodic breathing vs apneic spells

Treatment

A

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
Q

Preterm infants

Assessments

A

< 37wks

Assessments- respiratory (⬇️ surfactant), thermoregulation, fluid/electrolyte balance, skin, infection, pain, hypoglycemia (⬇️ feedings), immature liver, increases sepsis/decreased immunity

74
Q

Brown fat vs white fat

A

Brown fat- generates heat

White fat- adipose tissue , used for insulation in babies

75
Q

Factors affecting the assessment of thermoregulation in preterm babies

Interventions

A
  • skin - thin
  • brown fat - decreased amount
  • extremities - extended increasing exposure to air

Interventions- NTE neutral thermal environment

76
Q

Kidney regulation in preterm infants

A

Ability of the kidneys to concentrate or dilute urine is poor, causing a fragile balance between dehydration and overhydration

77
Q

Signs of dehydration in the newborn

A

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
Q

Signs of overhydration in the newborn

A

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
Q

Normal urine output for preterm baby

A

1-3 ml/kg/hr

80
Q

List 5 risk factors contributing to infections in preterm

A
  • 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
Q

pain in infants can cause

A

Hypoxia, hemorrhage, poor wound healing and poor growth

82
Q

Signs of pain in infants

A

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
Q

Interventions for increased stimulation from stressful environments

A

Schedule care

Reduce stimuli

Promote rest

Promote motor development

Individualize care & communicate

84
Q

A baby arching it’s back is a sign of ?

A

Stress

85
Q

Bronchopulmonary dysplasia

A

(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
Q

Intraventricular hemorrhage

A

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
Q

Retinopathy of prematurity

A

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
Q

Necrotizing enterocolitis

A

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
Q

Short bowel syndrome

A

Bowel that is shorter than normal causes inadequate absorption of fluids, electrolytes and nutrients

90
Q

Postterm infants

At risk for

A

> 42 weeks

Risk for- hypoxia, hypoglycemia, injury, meconium aspiration, hypothermia, jaundice

91
Q

Postmaturity syndrome

A

The fetus may not receive the appropriate amount of oxygen and nutrients and may be sga, resulting in hypoxia and malnourishment

92
Q

Small-for-gestational-age

At risk for, nursing considerations

A

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
Q

Symmetric growth restriction vs asymmetric growth restriction

A

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
Q

Large-for-gestational-age

Causes, risk for

A

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
Q

Macrosomia

A

Weigh more than 8lb 13oz to 9lb 15oz (4000-4500g)

96
Q

Low birth weight

A

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

Tests various (20 decks)

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