🤰🏾- Exam 4 Flashcards
Asphyxia
Insufficient oxygen and excess carbon dioxide in the blood and tissues
Factors contributing to asphyxia
Preterm lungs with insufficient surfactant
Maternal (hypertension, infection, drug use)
Placental (placenta previa, abruptio placentae, postmaturity)
Fetal (cord problems, infection, premature birth, multifetal gestation)
Transient tachypnea of the newborn
Risk factors, manifestations
(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
Infertility
Inability to conceive after 1 year of unprotected regular sexual intercourse
Primary vs secondary infertility
Primary- never conceived
Secondary- unable to conceive a second time
What are the 4 factors contributing to infertility in males
Abnormal sperm
Abnormal erections
Abnormal ejaculation
Abnormal seminal fluid
Causes of abnormal sperm
- 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
Causes of abnormal erections
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
Retrograde ejaculation
Causes
Release of semen backward into the bladder
Causes: DM, neuro disorders, surgery that effects sympathetic nerves, antihypertensives and psychotropics, hypospadias, anxiety
Abnormal seminal fluid
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
What are the 9 factors contributing to infertility in females
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
Gnrh, FSH , LH
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
Evaluation of infertility
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
What are the therapies used to facilitate pregnancy
Medications
Surgery
Insemination: sperm is placed into uterus
Egg donation: donor egg
Surrogate parenting
Clomiphene citrate
Clomid
Induces ovulation by increasing frequency of GnRH secretion from the hypothalamus, thus increasing FSH and LH release
Bromocriptine
Parlodel
Corrects excess prolactin secretion by anterior pituitary , improving LH and FSH secretion
hCG
Causes the corpus luteum to release progesterone to maintain the pregnancy
Ovarian hyperstimulation syndrome
Caused by too much hormone secretion
Ovarian enlargement with exudation if fluid and protein into the woman’s peritoneal and pleural cavities
In vitro fertilization
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
Gamete intrafallopian transfer
Sperm and ova are injected into Fallopian tube
Zygote intrafallopian transfer
Aka tubal embryo transfer
Fertilized ova is placed in Fallopian tube
What type of contraceptives should be avoided in perimenopausal women and why
No oral contraceptives due to increased risk of stroke and coronary artery disease
Vasectomy
Male sterilization by cutting a section of the vas deferens, which carries spent from the testes to the penis
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
Action of Mirena
Continuously releases progestin , which thickens cervical mucus and prevents transport of sperm into the endometrial cavity and Fallopian tubes
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
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
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
Combination OCs
Contain estrogen and progestin
Most common
Cause thickening of cervical mucus , suppress production of LH and FSH
Results in shorter, lighter periods
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
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
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)
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
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
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
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
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
Mittelschmerz
Pain on ovulation
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
How is breastfeeding an alternative method of contraception
Breastfeeding inhibits ovulation because suckling and prolactin interfere with secretion oh GnRH and LH
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
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
Vassopresors
Antihypotensive
Raise low blood pressure
Ethics vs bioethics
Ethics- involves determining the best course of action in a certain situation
Bioethics- application of ethics to health care
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
Utilitarian model
Concerned more with the consequences of actions than the actions themselves
Ex: the end justifies the means
Beneficence
Decision that produces greatest good or the least harm
Nonmaleficence
Avoid harming others
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
Justice
All people should be treated equally and fairly regardless of disease or social or economic status
Accountability
Accept responsibility for actions
Confidentiality
Keep information private
Veracity
Tell the truth
Fidelity
Keep promises that can be kept
Mandated contraception
Used as a condition of probation allowing women accused of child abuse to avoid jail terms
Interferes with constitutional rights
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
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
What are the 4 requirements of informed consent
Patients competence to consent
Full disclosure of information needed
Patients understanding of information
Patients voluntary consent
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
ECMO
Oxygenates blood while bypassing the lungs, allowing the lungs to rest temporarily and recover
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
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
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
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)
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
Normal range of hemoglobin and hematocrit
Hemoglobin- males: 14-18 , females: 13-16
Hematocrit- males: 40-54% , females: 36-48%
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
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
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
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
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
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
Preterm infants
Assessments
< 37wks
Assessments- respiratory (⬇️ surfactant), thermoregulation, fluid/electrolyte balance, skin, infection, pain, hypoglycemia (⬇️ feedings), immature liver, increases sepsis/decreased immunity
Brown fat vs white fat
Brown fat- generates heat
White fat- adipose tissue , used for insulation in babies
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
Kidney regulation in preterm infants
Ability of the kidneys to concentrate or dilute urine is poor, causing a fragile balance between dehydration and overhydration
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
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
Normal urine output for preterm baby
1-3 ml/kg/hr
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
pain in infants can cause
Hypoxia, hemorrhage, poor wound healing and poor growth
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
Interventions for increased stimulation from stressful environments
Schedule care
Reduce stimuli
Promote rest
Promote motor development
Individualize care & communicate
A baby arching it’s back is a sign of ?
Stress
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
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
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
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
Short bowel syndrome
Bowel that is shorter than normal causes inadequate absorption of fluids, electrolytes and nutrients
Postterm infants
At risk for
> 42 weeks
Risk for- hypoxia, hypoglycemia, injury, meconium aspiration, hypothermia, jaundice
Postmaturity syndrome
The fetus may not receive the appropriate amount of oxygen and nutrients and may be sga, resulting in hypoxia and malnourishment
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
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)
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
Macrosomia
Weigh more than 8lb 13oz to 9lb 15oz (4000-4500g)
Low birth weight
Infants weighing 5lb 8oz (2500g) or less at birth and of ANY gestational age
