Final Exam - Misc. Flashcards
What factors define pathologic hyperbilirubinemia?
- Serum bilirubin above 95th percentile
- Jaundice that develops in the first 24 hr
- Rise in serum bilirubin >2 mg/dL/hr,
- Jaundice that persists >2 weeks in term infant
What is the overarching cause of pathologic hyperbilirubinemia?
Most common causes: disease processes that ↑ hemolysis and ↑ bilirubin production.
What are the specific processes that can cause pathologic hyperbilirubinemia?
- ABO incompatibility
- Known hemolytic disease of the newborn
- ↑ RBC breakdown from cephalohematoma or polycythemia (post-maturity, maternal diabetes, twin-to-twin transfusion, low fetal O2 levels)
- Sepsis
- Extensive bruising
- Poor breastfeeding
What conditions can lead to polycythemia in a newborn that lend to hyperbilirubinemia?
Post-maturity
Maternal diabetes
Twin-to-twin transfusion
Low fetal O2 levels
What is polycythemia?
An increase in the absolute red blood cell mass in the body.
What condition in the newborn is possibly caused by the following conditions?
Post-maturity
Maternal diabetes
Twin-to-twin transfusion
Low fetal O2 levels
Polycythemia
What condition in the newborn is caused by polycythemia?
Hyperbilirubinemia
What lever of serum bilirubin can cause cell death and necrosis?
Serum bilirubin levels >25 mg/dL can cause cell death and necrosis.
What is BIND?
Bilirubin-induced neurologic dysfunction (BIND) whereby bilirubin crosses blood-brain barrier & binds to brain tissue.
What happens in BIND?
Bilirubin crosses blood-brain barrier & binds to brain tissue.
What is the clinical manifestations of BIND?
Acute bilirubin encephalopathy (ABE) = the clinical manifestations of BIND. ABE may be permanent or reversible.
What is ABE?
Acute bilirubin encephalopathy.
Is ABE permanent or reversible?
Can be either.
What is kernicterus?
Kernicterus = permanent, irreversible effects of BIND (usually ABE s/s first)
Risk for kernicterus increases as serum bilirubin levels increase (>25 = 6%, >30 = 14-25% risk)
Nearly all infants with bili >35 have kernicterus
What is the level of bilirubin that is the risk for kernicterus?
Nearly all infants with bili >35 have kernicterus
The risk for kernicterus increases with what?
Risk for kernicterus increases as serum bilirubin levels increase (>25 = 6%, >30 = 14-25% risk)
What is the progression in a neonate for bilirubin levels >25 mg/dL?
- BIND - Bilirubin-induced neurologic dysfunction (bilirubin binding to brain tissue)
- ABE - Acute Bilirubin Encephalopathy (clinical manifestations of BIND)
- Possibly Kernicterus
(irreversible effects of BIND)
Symptoms of BIND
Lethargy
Fever
Irritability
Jitteriness
Hypotonia
Poor feeding
Apnea
Seizures
High-pitched cry
Symptoms of Kernicterus
Cerebral palsy
Sensorineural hearing loss
Gaze abnormalities
Dental enamel dysplasia
What condition in the neonate are the following symptoms of?
Cerebral palsy
Sensorineural hearing loss
Gaze abnormalities
Dental enamel dysplasia
Kernicterus
What condition are the following symptoms of in the neonate?
Lethargy
Fever
Irritability
Jitteriness
Hypotonia
Poor feeding
Apnea
Seizures
High-pitched cry
BIND
What is the treatment for infants with BIND and ABE?
Infants w/ BIND and ABE are treated with an exchange transfusion regardless of bilirubin levels.
T/F: Infants with BIND and ABE are treated with an exchange transfusion based on a bilirubin level > 35 mg/dL.
False. Infants w/ BIND and ABE are treated with an exchange transfusion regardless of bilirubin levels but definitely w/ serum bili ≥25 mg/dL with neurologic symptoms.
Nursing assessments for hyperbilirubinemia
- Visual inspection for jaundice
- Check ABO compatibility (maternal & newborn)
- Monitor serum bilirubin levels
- Maintain thermoregulation
- Assess for s/s of ABE
What are the parameters of phototherapy for jaundiced newborns?
- Continuous if serum bilirubin ≥20 mg/dL
- May be interrupted for feeding/bonding if serum bili <20 mg/dL)
What type of complication is Meconium Aspiration Syndrome (MAS)?
Pulmonary.
What is Meconium Aspiration Syndrome (MAS)?
Aspiration of meconium-stained amniotic fluid.
What complications result from MAS?
- Leads to respiratory disease, hypoxemia and acidosis
- Also caused by intrauterine stress
How is MAS diagnosed?
- S/S present w/in 15 minutes of birth
- Confirmed by chest x-ray
- Arterial blood gasses
Which infants are at greatest risk of MAS?
Greatest risk in infants that are post-term or SGA.
What are the interventions for a newborn with MAS?
O2 supplementation
Mechanical ventilation
Surfactant therapy
Nitric oxide
ECMO
Correction of metabolic abnormalities (acidosis, hypoglycemia)
Antibiotics as indicated
What condition in the newborn is treated with the following interventions?
O2 supplementation
Mechanical ventilation
Surfactant therapy
Nitric oxide
ECMO
Correction of metabolic abnormalities (acidosis, hypoglycemia)
Antibiotics as indicated
Meconium aspiration syndrome (MAS)
What is the cause of meconium aspiration syndrome (MAS)?
Chronic asphyxia and infection can lead to meconium staining of the amniotic fluid, which is then aspirated by the fetus.
For what condition in the newborn does the following cause?
Chronic asphyxia and infection can lead to meconium staining of the amniotic fluid, which is then aspirated by the fetus.
Meconium aspiration syndrome (MAS)
What are the S/S of meconium aspiration syndrome (MAS)?
Meconium stained amniotic fluid
Respiratory or neurologic depression at birth
Postmature or SGA
Cyanosis
Acidosis
Rales/rhonchi
Pneumothorax
What necrotizing enterocolitis?
Ischemic necrosis of the intestines
How emergent is necrotizing enterocolitis?
It’s a medical emergency
What newborns are at greatest risk for necrotizing enterocolitis?
Greatest risk in preterm, low birth weight infants, especially those under 1,500 gms.
What condition do these factors put a newborn at risk for?
Underdeveloped mucosa of intestines permeable to bacteria combined w/ immature immune response – unable to combat infection.
Necrotizing enterocolitis
What treatment is available for necrotizing enterocolitis?
Antenatal corticosteroid therapy and human breast milk are protective against NEC.
What is the first sign of necrotizing enterocolitis?
First sign of problem is usually feeding intolerance.
What are complications from necrotizing enterocolitis?
Complications: infection, sepsis, DIC, respiratory failure, and metabolic issues (hypoglycemia & metabolic acidosis).
What condition in the newborn has the following complications?
Complications: infection, sepsis, DIC, respiratory failure, and metabolic issues (hypoglycemia & metabolic acidosis).
Necrotizing enterocolitis
Interventions for necrotizing enterocolitis.
Bowel rest - d/c enteral feedings
NG suctioning for GI decompression
TPN for nutrition and fluids as needed
Cardiac support: meds to correct hypotension
May need respiratory support
For what condition are the following interventions?
Bowel rest - d/c enteral feedings
NG suctioning for GI decompression
TPN for nutrition and fluids as needed
Cardiac support: meds to correct hypotension
May need respiratory support
Necrotizing enterocolitis.
What will imaging show on an newborn with necrotizing enterocolitis?
Inflamed intestinal wall with gas bubbles.
What does exposure to tobacco in utero cause in a newborn?
Vasoconstriction
Neonates of mothers who smoke may display what?
More irritability & hypertonicity
Less able to self-soothe
Maternal tobacco abuse can cause what high risk conditions in pregnancy?
High risk for: preterm delivery, placental abruption, chorioamnionitis, preeclampsia, PPROM.
What are the risks to the newborn after delivery to a mother who abused tobacco during pregnancy?
Risks after delivery: SIDS, T2DM, behavioral problems (ADHD), asthma, may increase risk for schizophrenia and Tourette’s syndrome.
Smoking can negatively impact breastmilk production, taste & composition, leading to poor weight gain; infants tend to sleep poorly and for shorter duration.
What are the following conditions indicative of?
Risks after delivery: SIDS, T2DM, behavioral problems (ADHD), asthma, may increase risk for schizophrenia and Tourette’s syndrome.
Decreased breastmilk production, taste & composition, leading to poor weight gain; infants tend to sleep poorly and for shorter duration.
Maternal tobacco use.
What interventions are recommended for a pregnant mother who uses tobacco?
Care: encouraging smoking cessation (*or reduction), especially in 1st trimester, greatly reduces complications of pregnancy & risks to the newborn.
What newborn condition is associated with opioid use in the mother?
Neonatal Abstinence Syndrome (NAS)
When does opioid withdrawal start in a newborn?
Opioid withdrawal usually starts 48-72 hours after birth or up to 5 days after birth.
Opioid withdrawal affects what 4 domains?
State control and attention
Motor and tone control
Sensory integration
Autonomic functioning
What are the risks of opioid withdrawal in a neonate?
High risk for respiratory complications and seizures; SIDS after discharge .
What are the treatments for neonatal abstinence syndrome?
Opioids (morphine, methadone, buprenorphine) - weaned over time.
What are the supportive interventions for neonatal abstinance syndrome?
Swaddling, rocking, laid on side; minimize auditory, tactile and visual stimuli; pacifier for self-regulation; small, frequent feedings; encourage breastfeeding.
What are the S/S of neonatal abstinence syndrome?
General: irritable, high-pitched crying, sleep/wake disturbances, failure to thrive.
Movement: Hypertonia, hyperactive reflexes, tremors, skin excoriation.
GI: Disorganized feeding, vomiting, frequent loose stools.
Autonomic dysfuction: Sweating, sneezing, mottled skin, fever, nasal stuffiness, yawning.
The following are S/S of what condition in the newborn?
General: irritable, high-pitched crying, sleep/wake disturbances, failure to thrive.
Movement: Hypertonia, hyperactive reflexes, tremors, skin excoriation.
GI: Disorganized feeding, vomiting, frequent loose stools.
Autonomic dysfuction: Sweating, sneezing, mottled skin, fever, nasal stuffiness, yawning.
Neonatal abstinence syndrome
What is the most common illicit drug used in pregnancy?
Marijuana
Maternal marijuana use in pregnancy may impact the newborn’s:
Intelligence
Attention span
Visual memory
Executive function
May be more susceptible to depression & anxiety
Memory deficits
T/F: Mother’s who use marijuana are still encouraged to breastfeed.
False. They are discouraged from breastfeeding.
What is responsible for a significant cause of neonatal sepsis?
GBS
What has reduced rates of newborn sepsis dramatically?
Screening for GBS prenatally and giving GBS+ mothers antibiotics during labor.
What is early onset GBS in newborns?
Early onset GBS: neonatal infection from ROM (presents 24 hrs – 1 week after birth).
What are the risk factors for a newborn getting SEPSIS from a GPS infected mother?
Risk factors: preterm delivery, PROM, ROM ≥18hrs before delivery, GBS in urine during pregnancy, prior delivery of infant w/ GBS, Temp ≥100.4 during delivery, heavy maternal colonization.
The following are risk factors for what condition in a newborn?
Preterm delivery, PROM, ROM ≥18hrs before delivery, temp ≥100.4 during delivery, heavy maternal colonization.
SEPSIS from a GBS infected mother.
What are the diagnostic tests for SEPSIS in a newborn from a GBS mother?
Diagnostic tests: blood culture, lumbar puncture, CBC w/ differential & platelets, chest x-ray if respiratory symptoms present.
What is usually done to reduce transmission risk of HIV to a newborn?
C-section usually recommended at 38 weeks to reduce transmission risk
Women should continue ART therapy throughout labor & delivery.
T/: Pregnant women with HIV should discontinue ART therapy during pregnancy.
False. Women should continue ART therapy throughout labor & delivery.
What is the treatment during pregnancy for mother’s who are HIV+?
Treatment: ART during pregnancy & intrapartum, then postpartum for the infant → ART w/in 6-12 hrs after birth.
T/F: Breastfeedlng is recommended for women who are HIV+.
False. Breastfeeding is contraindicated (in high resource settings = U.S.)
A nurse is admitting a client who is in labor and has HIV. Which of the following interventions should the nurse identify as contraindicated for this client? Select all that apply.
Episiotomy
Oxytocin infusion
Forceps
Cesarean birth
Internal fetal monitoring
Episiotomy
Oxytocin infusion
Forceps
Internal fetal monitoring
A nurse is teaching a newly licensed nurse about neonatal abstinence syndrome. Which of the following statements by the newly licensed nurse indicate understanding of the teaching?
“The newborn will have decreased muscle tone.”
“The newborn will have a high-pitched cry.”
“The newborn will sleep for 2-3 hours after a feeding.”
“The newborn will have mild tremors when disturbed.”
“The newborn will have a high-pitched cry.”
What is the cause of respiratory distress syndrome (RDS)?
Caused by insufficient surfactant and immature lungs.
What happens to the alveoli in respiratory distress syndrome?
The alveoli collapse with expiration leads to reduced ability to expand which leads to hypoxemia.
S/S of newborn respiratory distress syndrome
Signs and symptoms:
Low oxygen saturation (*optimal range is between 90-95% O2 sat)
Infant pale / cyanotic
Decreased lung sounds
Nasal flaring & retractions
Expiratory grunting
Use of accessory muscles of breathing
Tachypneic
Crackles if pulmonary edema present
What are the treatments/supportive techniques for newborn respiratory distress syndrome.
Treatment includes:
- Respiratory support with either CPAP or positive end expiratory pressure (PEEP) to keep alveoli open
- Surfactant therapy (usually w/in 30-60 min of birth)
Supportive care:
To decrease stress on neonate → maintain thermoregulation, provide adequate nutrition, maintain appropriate blood pressure, monitor I&O.
What condition in the neonate are the following treatments for?
- Respiratory support with either CPAP or positive end expiratory pressure (PEEP) to keep alveoli open
- Surfactant therapy (usually w/in 30-60 min of birth)
Respiratory distress syndrome
T/F: Inadequate neonatal pain management can have long-term effects on how the neonate responds to pain throughout his or her life.
True.
T/F: Pain in neonates should be treated based on how much pain the baby is in.
False. Pain should be treated preemptively when possible.
Options for pain management in a newborn include:
Breastfeeding
Nonnutritive sucking (pacifier)
Skin-to-skin contact
Oral sucrose
Topical anesthesia
Acetaminophen or opioid analgesics
Nerve block with lidocaine
Swaddling
The following are interventions for what in newborns?
Breastfeeding
Nonnutritive sucking (pacifier)
Skin-to-skin contact
Oral sucrose
Topical anesthesia
Acetaminophen or opioid analgesics
Nerve block with lidocaine
Swaddling
Pain management in newborns.
Parameters for neonatal pain assessment - Physiologic
Change in vitals signs: heart rate, respiratory rate, blood pressure
Change in respiratory: breathing pattern, oxygen saturation
Change in integumentary: Sweating of palms, skin color change
Other changes: Increased intracranial pressure, change in heart rate variability, change in pupil size.
Parameters for neonatal pain assessment - Behavioral
Behavioral responses:
Crying (crying pattern, acoustic nature of cry, not consolable)
Movement (facial expression change, hand and body movements, muscle tone changes
A preterm infant is scheduled to have a new peripheral IV line inserted. How might the nurse best address pain related to this procedure?
A. Observe the infant for signs of pain during the procedure.
B. Understand that neonates do not experience pain.
C. Swaddle the infant and provide a pacifier before the procedure.
D. Administer opioid analgesics prior to the procedure.
C?
A client with diabetes gives birth to a full-term neonate who weights 10 lb, 1 oz (4,600 g). While caring for this large-for-gestational-age (LGA) neonate, the nurse palpates the clavicles for which reason?
Neonates of mothers with diabetes have brittle bones.
Clavicles are commonly absent in neonates of mothers with diabetes.
LGA neonates have glucose deposits on their clavicles.
One of the neonate’s clavicles may have been broken during birth.
One of the neonate’s clavicles may have been broken during birth.
The nursing instructor is leading a discussion with a group of nursing students who are analyzing the preterm infant’s physiologic immaturity and the associated difficulties the newborn and family must deal with. The instructor determines the session is successful when the students correctly choose which body system that presents with the most critical concerns related to this immaturity?
The musculoskeletal system
The respiratory system
The endocrine system
The genitourinary system
The respiratory system?
What is transient tachypnea of the newborn (TTN)?
A self-limiting form of pulmonary edema resulting from delayed clearance & reabsorption of fetal alveolar fluid. Decreased compliance of lungs causes tachypnea & hypoxemia
Usually manifests w/in 2 hrs after birth & resolves w/in 24-72 hrs.
If no improvement in ~24 hrs, evaluate for pneumonia and sepsis.
Common contributor: cesarean delivery
What condition is a self-limiting form of pulmonary edema resulting from delayed clearance & reabsorption of fetal alveolar fluid?
Transient tachypnea of the newborn
In transient tachypnea of the newborn what does decreased compliance of the lungs cause?
Decreased compliance of lungs causes tachypnea & hypoxemia
What is a common contributor to transient tachypnea of the newborn?
Cesarian section
In what timeframe does transient tachypnea of the newborn manifest?
Usually manifests w/in 2 hrs after birth & resolves w/in 24-72 hrs.
If no improvement in ~24 hrs, evaluate for pneumonia and sepsis.
If there is no improvement within ~24 hours in transient tachypnea of the newborn, what should be tested for?
If no improvement in ~24 hrs, evaluate for pneumonia and sepsis.
What intervention is appropriate with transient tachypnea of the newborn?
Oxygen supplementation to keep sat >90%
Symptoms of transient tachypnea of the newborn:
Tachypnea
Nasal flaring
Grunting
Retractions
Cyanosis
Transient tachypnea of the newborn is common in what age of neonates?
Late preterm, term and post-term newborns.
What is a Papanicolaou test?
Pap smear
What does a Papanicolaou test do?
Detects precancerous or cancerous cells on the cervix
What test helps to reduce invasive cancer rates and is associated with higher cure rates?
Papanicolaou test.
What is the procedure for a pap smear?
Pelvic exam with a speculum
Small number of cervical cells are collected from the outer cervix and the cervical os
What is the cervical os?
The opening to the cervix.
Screening recommendations for pap smear.
First screening: 21yo regardless of sexual activity, every 3 years until 30 yo
> 30 yo: Pap test and HPV testing every 5 years until 65yo or a Pap test alone every 3 years.
> 65 yo: no screening unless at increased risk for cervical cancer.
What is the recommendation to start having a pap smear?
At 21 years of age and then q 3 years until 30 years of age.
What is the recommendation for a pap smear for women > 30?
From 30 - 65 years of age, a pap smear q 3 years or a pap and HPV test q 5 years.
What is the recommendation for a pap over age 65?
> 65 years, no screening unless at increased risk for cervical cancer.
What is the progression of cervical cancer.
What is the cause of cervical cancer?
The human Papillomavirus (HPV)
What is the most common sexually transmitted infection (STI) in the U.S?
HPV
What are non-modifiable risk factors for cervical cancer?
Diethylstilbestrol (DES)
Family History
What condition are the following modifiable risk factors for?
HPV
Sexual History
Smoking
Immunocompromised
Chlamydia
Long-term use of oral contraceptives
Having multiple multiple full-term pregnancies
Economic status
Diet low in fruits and vegetables
Mammogram recommended screening
40yo: mammograms routine screening
40yo to 49yo: every 1 to 2
50yo to 75yo: mammogram every 1 to 2 years
>75yo: mammograms based on share decision making
Recommendations for routine breast exams.
29-39 years - q 1 to 3 years
> 40 - Annually
T/F: Breast self-examination is recommended for screening because of efficacy.
False. Breast self-examination is also no longer recommended for screening because of lack of efficacy.
Of the breast cancers discovered by women (rather than mammograms), most women identified changes during her routine (e.g., dressing, showering, etc.) and not by self-examination.
How were breast cancers discovered by women, not by mammograms, detected?
Most women identified changes during her routine (e.g., dressing, showering, etc.) and not by self-examination.
The following are modifiable or non-modifiable risks for what condition?
Getting older
Genetic mutations
Dense breast
Hx of breast CA
Hx of non-cancerous breast disease
Family Hx breast CA
Family Hx ovarian CA
Radiation therapy
Diethylstilbestrol (DES)
Non-modifiable for breast cancer
What drug is a non-modifiable risk facttor for both breast and cervical cancer?
Diethylstilbestrol (DES)
What are the modifiable risk factors for breast cancer?
Physically inactive
Overweight
Obesity after menopause
Hormone therapy
Reproductive History
Drinking alcohol
Role of the nurse to detect IPV:
Promote universal screening
Implement variety of screening methods
Reduce barriers to screening
Decrease provider discomfort
Normalize questions: “Violence in relationships is common. We like to screen all our patients for safety in their relationships so we can offer help as needed.”
Isolate patient from partners
Report suspicions and provide the facts (mandated reporter)
Consult as needed
When should all incarcerated women be tested from pregnancy?
At the time of incarceration and 2 weeks later.
Women who are incarcerated have a higher or lower risk for pregnancy complications.
Higher risk.
Where is most prenatal care in prisons offered?
May not be provided in prisons/correctional facilities; often managed off-site.
What accommodations are often available for postpartum care?
Few facilities have available accommodations for infants on site; infants often given to family, foster care, or adoption.
What percentage of women get pregnant within 3 months of release from prison?
About half of women released from incarceration become pregnant within 3 months.
A nurse is working as part of a group of health care providers implementing a community health initiative for primary prevention of cervical cancer. The nurse would focus educational efforts on which areas? Select all that apply.
- Steps to prevent sexually transmitted infections (STIs)
- Early treatment for abnormal Papanicolaou test
- Consistent use of barrier contraception
- Immunization with the human papillomavirus (HPV) vaccine
- Pelvic rest after surgery
- Steps to prevent sexually transmitted infections (STIs)
- Consistent use of barrier contraception
- Immunization with the human papillomavirus (HPV) vaccine
During a gynecologic examination, a client asks why breast self-examination (BSE) is no longer being encouraged. Which response will the nurse make?
“Too many people do it incorrectly.”
“Being aware of the breasts is being encouraged instead.”
“It has caused too many people to be upset, so it is not supported anymore.”
“Being aware of the breasts is being encouraged instead.”
What are contraindications for COC’s?
- Breastfeeding
- Migraine with aura
- Hx of blood clots
- Smoking > 35 yrs old
- HTN
The most effective methods of birth control are:
Bilateral tubal ligation (BTL)
Vasectomy
LARC - long-acting reversible contraception (contraceptive implants and intrauterine contraception)
How do combined oral contraceptives work?
Works by increasing viscosity of cervical mucus, suppressing ovulation, and thinning the uterine lining.
What is the normal dosing for COCs?
Generally, contain 21 hormone-containing pills followed by 7 placebo pills.
What is an alternative dosing method for COCs?
An alternative method is known as extended cycling. (An example of alternative method packaging is 84 hormone pills followed by 7 placebo pills.)
What are contraindications to COCs?
breastfeeding
migraine with aura
history of blood clots
smoking > 35 years old
hypertension
How long can a woman remain on COCs?
Healthy, nonsmokers may take the pill until menopause (which may help control discomforts of perimenopause).
Can COCs help control the discomforts of perimenopause?
Yes.
Which COCs are safe for breastfeeding?
Progestin-only.
What is a primary side effects of progestin-only COCs?
Primary side effect is a less regular period and more breakthrough bleeding.
If pregnancy occurs while using progestin-only COCs, what are the implications and why would that occur?
If pregnancy does occur, more likely to be ectopic due to slowing of cilia in fallopian tube in response to progestin.
What are the active ingredients in the contraceptive ring?
Contraceptive rings are flexible silicone rings impregnated with estrogen and progestin.
How is the contraceptive ring used?
The woman places the ring inside her vagina for 3 weeks, removes it for a week to create a withdrawal bleed, and then replaces it with a new ring.
What can dislodge a contraceptive ring?
A bowel movement.
How does a woman with a contraceptive ring have sex?
Ring can be removed for intercourse and left out for up to 3 hours per day.
With a contraceptive patch, is a week bleed required?
A contraceptive patch contains estrogen and progestin and is applied weekly for 3 weeks. Followed by a patch-free week, which will cause a withdrawal bleed.
What hormones are in the contraceptive patch?
Estrogen and progestin.
The contraceptive patch should be applied to what parts of the body?
The patch should be applied on the upper back, upper arm, upper buttock, or lower abdomen, but not on the breast.
The woman should rotate the cite weekly to avoid skin irritation.
What are the two meds for emergency contraception?
Levonorgestrel (Plan B)
Ulipristal (Ella)
Which med, Levonorgestrel or ulipristal, is OTC and which by prescription?
LevoOver the counter or by prescription. Ulipristal is prescription only.
Which med, Levonorgestrel or Ulipristal, is better within 72 hours of unprotected sex?
Levonorgestrel. Ulipristal is better within 120 hours of unprotected sex.
Which meds, levonorgestrel or ulipristal, will prevent ovulation?
Levonorgestrel works by preventing ovulation and does not affect an established pregnancy.
Ulipristal may affect an existing pregnancy.
Is patient weight a factor in emergency contraception?
Yes. Levonorgestrel is better for those <165 lbs, while Ulipristal is more effective for those >165 lbs.
How does Depomedroxyprogesterone acetate (DMPA, brand name: Depo Provera) administered?
Depomedroxyprogesterone acetate (DMPA, brand name: Depo Provera) is a progestin-only injection given every 13 weeks until pregnancy is desired.
How does depo provera work?
DMPA works by inhibiting follicle maturation and ovulation.
What is Nexplanon?
4 cm rod of nonestrogen etonogestrel (NOT estrogen) in skin of bicep, approved for 3 yrs of use.
How soon after removing nexplanon can a woman get pregnant?
Within 30 days.
Is BMI a consideration in using Nexplanon implant?
Yes, a BMO over 30 may make nexplanon less effective.
What is a common side effect of the Nexplanon implant?
Unschedule bleeding.
What are IUCs (IUDs)?
Intrauterine contraception (IUCs or IUDs) are T-shaped plastic devices wrapped in copper or containing progestin that are inserted into the uterus.
What are the side effects/risks of IUCs/IUDs?
The side effect of IUCs/IUDs is a change in bleeding patterns and risk of perforation upon insertion.
Typically within the 1st year, what can happen with an IUC/UID?
Spontaneous expulsion of the IUC may occur (typically within the first year of use).
What are women screened for before placement of an IUC/IUD?
Women are screened for STIs. With this practice, the incidence for pelvic inflammatory disease is the same for women with IUCs as for women without them
How does the copper IUC work?
The copper IUC works by inhibiting sperm motility, capacitation, survival, and phagocytosis.
The copper IUC can be inserted as emergency contraception within 5 to 7 days of unprotected intercourse.
How far after unprotected sex and a copper IUC/IUD be inserted?
The copper IUC can be inserted as emergency contraception within 5 to 7 days of unprotected intercourse.
Will a copper IUC/IUD disrupt an existing pregnancy?
There is no evidence of any ICU acting as an abortifacient or disrupting an existing pregnancy.
What are the two types of IUC/IUDs?
Copper and progesterone-containing
How does a progesterone-containing
Progesterone (Mirena, Skylar, Kyleena)
The progestin IUD causes inhospitable changes to the cervical mucus, endometrial atrophy, and variable effects on ovulation.
What are the side effects of a progestin-containing IUC/IUD?
The progestin IUC may decrease menstrual bleeding and increase spotting.
How does a copper IUC/IUC affect menstruation?
The copper IUC may result in heavier bleeding
What education should accompany an IUC/IUD?
Report new acute cramping.
What are two types of contraception barriers?
Chemical and mechanical
What type of contraception are the following?
Male condom
Female condom
Sponge
Diaphragm
Cervical cap
Mechanical barriers
What are the five types of mechanical barriers for contraception?
Male condom
Female condom
Sponge
Diaphragm
Cervical cap
With typical use, a male condom has a contraception failure rate of what?
18%
Should a new condom be used with each episode of oral, rectal, or vaginal sex with a partner whose STI status is unknown?
Yes.
What is a diaphragm?
The diaphragm is a flexible saucer that is placed into the vagina to cover the cervix.
Is a diaphragm effective against STIs?
It does not protect against STIs.
What is the failure rate against pregnancy from a diaphragm?
12%
When should the fit of a diaphragm be checked?
Fit should be checked if the woman gives birth, has a miscarriage or abortion, or gains or loses more than 10 pounds.
How often should a diaphragm be replaced?
q 2 years
The natural family planning method of birth control relies on what?
NFP also known as the rhythm method of birth control relies on the predictability of the female cycle and timing intercourse.
With the natural family planning method, when should unprotected sex be avoided?
On days 8 through 19 of the menstrual cycle.
What is the failure rate of natural family planning?
With typical use, there is a 12% failure rate over one year with this method.
What are the two least effective methods of birth control?
Breastfeeding and withdrawal.
What is a common med regimen for medical abortion?
200 mg of mifepristone followed by 800 μg of misoprostol 6 hours later.
200 mg of mifepristone followed by 800 μg of misoprostol 6 hours later is used for what?
To abort a child.
Surgical abortion is typically done by what?
Uterine aspiration (dilation and curettage).
Later abortions are accomplished by what technique?
Later abortion is generally by dilation and evacuation.
Medical abortions usually occur before what point in gestation?
Within 70 days (10 weeks)
What interventions should be done after an abortion?
Observe patients for signs of hemorrhage and intra-abdominal bleeding by monitoring vital signs, pain, and bleeding, for at least 30 minutes after the procedure.
Rho (D) immune globulin administered to Rh- women.
Infertility is defined as what?
Lack of pregnancy after 12 months of well-timed intercourse.
6 months if the woman is over 35 years old.
Can depo provera be used as a method of birth control while breastfeeding?
Yes.
What is the frequency of prenatal care appointments?
Until week 28 - q 4 weeks
Between 28 and 36 weeks’ gestation q 2 weeks.
After 36 weeks q week.
What does GTPAL stand for?
GTPAL stands for:
- Gravidity (# of pregnancies including current)
- Term (# of pregnancies carried to 37+ weeks)
- Preterm (# of pregnancies carried between 20 and 36 6/7 weeks)
- Abortion (# of losses before 20 weeks); - Living (# of living children)
When is Rhogham administered?
If mom is Rh negative during:
Ectopic
GTD (molar) pregnancy
Trauma
What are the parameters of postpartum blues (baby blues)?
Self limiting, starts 2-3 days after delivery, resolves in 2 weeks.
Is considered normal.
The following are warning signs of what condition?
Low mood for at least 2 weeks
Negative attitude toward the infant
Anxiety about the health of the infant
Concern about the ability to care for the infant
Use of alcohol, street drugs, drugs prescribed to others, or tobacco
Postpartum depression
How is postpartum depression diagnosed?
Must meet 5 of 9 criteria during 2-week period with at least one symptom being depressed mood or diminished pleasure in all/most activities
How is postpartum psychosis diagnosed?
- Distorts reality with hallucinations, thought disorganization, disorganized behavior, delusions
- May occur within 48 hours of birth
Who is at risk for postpartum psychosis?
Those with depression, schizophrenia, schizoaffective disorder, psychosis.
How many points available on an APGAR and what’s the breakdown for interventions?
Total 10 pts
4-6: administer oxygen, suction, stimulate, rub baby’s back
0-3: administer full resuscitation
What are the 5 parameters of the APGAR
Appearance, pulse, grimace, activity, respiration
What is a circumcision and when is it done?
● An elective procedure that removes of the foreskin of the penis
● Done within 1 to 8 days of life
Contraindications to circumcision
Contraindications to procedure: penile anomalies, bleeding abnormalities, or medical instability.
How old does a newborn have to be for circumcision?
Be at least 12 hours old and void prior to circumcision.
4 things to do before circumcision?
- No feeding at least one hour prior to procedure
- Vitamin K should be administered prior to procedure
- Parental consent needed
- Pain relief required for procedure
Care of circumcision
● Apply pressure to area
● Superficial stitches
● Wrap penis in gauze covered with petroleum jelly
● Maintain for at least 3 to 5 days
● Minimized contact with urine and feces
Normal findings after circumcision
Normal findings
● Swelling
● Yellowish crust on penis
● Blood tinged diaper less than quarter in size
● Should void within 12 hours of procedure
Meconium should pass within what time frame and should be what color?
Within 24 hours, thick dark green, tarry.
