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Mother Baby > Final Third of Class > Flashcards

Final Third of Class Flashcards

1
Q

what is the single most dangerous event in a lifetime for a female

A

pregnancy

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2
Q

medical uses of contraception (beyond preventing pregnancy)

A 
helps w/ irregular periods
reduces dysmenorrhea
decrease acne
treats PCOS
protection from PID, ovarian and endometrial cancer, fibrocystic breast disease, ovarian cysts, fibroadenomas of breast, anemia and STIs
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3
Q

least effective method of contraception

A

fertility awareness based d/t user error and complications

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4
Q

symptothermal

A

calendar/mucus/body temp/standard

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5
Q

what causes increase temp during ovulation

A

usually spike during ovulation d/t increased progesterone

use contraception that day and 3 days after

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6
Q

billings (mucus)

A

before ovulation - clear, water, stretchy (estrogen dominant)
thick, white and sticky when not fertile (spinnbarkeit)

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7
Q

Standard method: if you have a regular cycle (26-32).. when to avoid sex

A

days 8-19

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8
Q

calendar rhythm method

A

record cycles for 6 months
take shortest cycle and subtract 18 days
take longest cycle and subtract 11 days
don’t have sex b/w those days

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9
Q

barrier methods

A

second least effective
prevent sperm from entering uterine cavity
d/t user error and inconvenience

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10
Q

types of barrier methods

A

condoms (male and female)
contracetpive sponge
cervical cap
diaphragm

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11
Q

contraceptive sponge

A

moisten sponge with water

leave in place for 6-8 hours post coital (less than 24 hours)

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12
Q

What to avoid with condoms (3)?

A

avoid oil based lubricants, monistat, estrogen creams

Also female condom can be inserted 8 hours prior to coitus

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13
Q

diaphragm

A 
requires fitting and referring
requires spermicide
leave in place for 6-8 hours post coital
no more than 24 hours
clean with soap and water
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14
Q

cervical cap

A

requires fitting
requires spermicide
leave in place for 6-8 hours post coital (no more than 48 hours)

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15
Q

spermicide risk

A

vaginal walls become more susceptible to HIV

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16
Q

hormonal methods

A

COC
vaginal ring
progestin minipill
patch

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17
Q

what pill do you use while breasfeeding

A

minipill = progestin only

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18
Q

COC pills

A

estrogen and progestin
extended use - 4 years

contraindicated with smokers

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19
Q

patch

A

weekly application for 3 weeks

slight risk of thromboembolism

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20
Q

vaginal ring

A

nuva ring

inserted for 3 weeks and removed for 7 days

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21
Q

depo-provera

A

progestin only

injected every 3 months

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22
Q

long-acting reversible (LARC)

A

intraueterine

nexplanon

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23
Q

IUD

A

Copper - 10 years - non hormonal

Progesterone - Mirena (5 yrs), Skyla (3 yrs), Liletta (3 yrs), Kyleena (3 years)

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24
Q

nexplanon

A 
sits under skin
progestin
good for only 3 years
prevents ovulation, thickens mucus
AE: weight gain, headaches, irregular menses, acne
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25
Q

most effective method of contraception

A

operative sterilization = vasectomy and tubal ligation

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26
Q

after getting vasectomy, how long does it take to clear remaining sperm?

A

3 months
15-20 ejaculations
*no effect on sexual function

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27
Q

post coital contraception

A

sooner taken, the more likely it’ll work (within 12 hours)

unlikely to prevent implantation

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28
Q

AE of post coital contraception

A

nausea, HA, irregular bleeding

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29
Q

what post coital contraception works by inhibiting or delaying contraception

A

plan B (w/i 72 hours) - progestin only - interferes with ovulation
ella (w/i 5 days) - progesterone modulator
yutze method - combined progestin-estrogen pill

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30
Q

what post coital contraception prevents fertilization

A

paraguard (within 5 days) - copper IUD

may affect oocyte and endometrium

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31
Q

pregnancy

A

implantation in the uterine wall of a fertizlied ovum, most fertilized eggs naturally fail to implant

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32
Q

What are the three things contraception can block to prevent pregnancy

A

interference with ovulation, fertilization or implantation

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33
Q

abortion

A

ends an established pregnancy after implantation

miscarriage and therapeutic

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34
Q

hormonal contraception

A

use estrogen/progestone to prevent ovulation and thicken cerivcal mucus

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35
Q

do LARCs, plan B and Ella disrupt existing pregnancies

A

no

plan b and ella work by preventing ovulation

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36
Q

t/f: hormonal and copper IUDs work by preventing sperm from reaching and fertilizing an egg

A

true - copper IUD can prevent implantation of a fertilized egg

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37
Q

TORCH

A 
Toxicplasmosis
Other - hep, sphyllis, Zika, HIV, parvovirus
Rubella
CMV
Herpes
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38
Q

down syndrome

A 
upward slant of eyes
epicanthal folds
flat facial profile
depressed nasal bridge
small nose
protruding tongue
small low set ears
short broad hands
simian crease
hyperflexibility
hypotonic muscles
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39
Q

fetal alcohol syndrome

A 
epicanthal folds
strabismus
ptosis
poor suck
small teeth
abnormal palmar creases
irregular hair
heart defects
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40
Q

what could be signs of congenital heart defect

A

cyanosis within 12-24 hours of birth but normal respiratory signs
could be a sign of cardiac issues like ductal dependent lesions

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41
Q

choanal atresia

A

unilateral or bilateral occlusion of posterior nares

bone is blocking 1 or 2 nasal passages

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42
Q

cleft palate/lip

A

cleft palate = opening on roof of mouth

cleft lip = extends from roof of mouth into lip and nasal passage

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43
Q

un-repaired trachea espohageal fistula

A

fistula b/w trachea and esophagus below normal openings to esophagus and trachea
and upper part of esophagus dead ends

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44
Q

congenital diaphragmatic hernia pre surgical repair

A

open in diaphragm wall - food contents can go up into chest cavity

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45
Q

choanal atresia assessment

A

cyanosis, retractions, noisy respirations, difficulty breathing during feeding

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46
Q

choanal atresia nursing interventions

A 
assess patency of nares
assist with passing nasal catheter
obtain ENT consult
maintain resp function
head elevation
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47
Q

cleft palate/lip assessment: what do they swallow a lot of

A

swallow a lot of air - opening b/w nasal passage and mouth

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48
Q

cleft lip and palate interventions

A 
burp frequently after each ounce
special nipple to use
obtain craniofacial/ENT consult
clean cleft with sterile water
support parental coping
place in side lying position but feed in upright position
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49
Q

un-repaired trachea espohageal fistula assessment

A

excessive drooling
abdominal distension
periodic chocking
cyanotic episodes

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50
Q

un-repaired trachea espohageal fistula nursing

A 
prevent aspirations
withhold feeding
elevate head
keep baby calm
antibiotics
low intermittent suction in pouch
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51
Q

congenital diaphragmatic hernia pre surgical repair assessment

A 
gasping respirations
nasal flaring
chest retractions
barrel chest
scaphoid abdomen
asymmetric chest expansion
diminished/absent unilateral breath sounds
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52
Q

congenital diaphragmatic hernia pre surgical repair nursing interventions

A

prepare for intubation
high semi fowlers
turn to affected side - allows for more lung expansion

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53
Q

CPAP

A

type of mechanical ventilation
helps newborns breathe - but newborns are breathing on their own
steady flow of air keeps alveoli from collapsing after each breath
less hazards than ventilators b/c they don’t have enough surfactant

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54
Q

CIs for CPAP

A

choanal atresia
cleft palate
un-repaired trachea esophageal fistula
congenital diaphragmatic hernia pre surgical repair

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55
Q

4 types of hyperbili

A

physiologic - benign
breastfeeding jaundice - benign - inadequate fluid intake, self limiting
breast milk jaundice - benign - issue with milk composition
pathologic

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56
Q

phototherapy is required when…

A

if bilirubin >20mg/dl

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57
Q

phototherapy steps

A 
remove clothing
cover eyes and check every 4 hours
check VS every 4 hours
cluster care
no lotion
reposition every 2 hours
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58
Q

bacterial vaginosis

A

most prevalent form of vaginal infection
a change in normal vaginal flora

avoid w/ loose cotton underwear, no perfumes in vaginal flora

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59
Q

treatment and diagnose: bacterial vaginosis

A

whiff test, absence of leukocytes
flagyl orally or flagyl/clindamycin cream (avoid alcohol with flagyl)

*partners do not need to be treated

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60
Q

s/s of bacterial vaginosis

A

asymptomatic

thin, watery white or grey discharge with odor

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61
Q

risks with bacterial vaginosis (7)

A

increased risk of:

  • PID
  • HIV
  • PTB
  • PROM
  • LBW
  • PTL
  • PP endometritis
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62
Q

nursing interventions: bacterial vaginosis

A

clindamycin cream: warn shouldn’t use condoms and diaphragms for 5 days b/c they interfere w/ treatment integrity
promote oral probiotics, vit B complex, avoid excessive products
follow up only if symptoms recur

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63
Q

tx for UTI

A

antibiotics

void when you need to!
empty bladder before and after sex
wipe from front to back

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64
Q

s/s of UTI

A 
asymptomatic
dysuria, urgency, frequency
fever
hematuria
chills
flank pain
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65
Q

nursing intervention for UTI

A

frequent screening and education

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66
Q

syphilis tx

A

test: VDRL (venereal disease research lab), RPR (rapid plasma antigen)
benzathine PCN G, Doxycycline/tetracycline

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67
Q

s/s of syphilis

A

chancre (4 weeks) followed by wartlike plaque for 6weeks - 6 months
slight fever
loss of weight
malaise

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68
Q

risks w/ syphilis

A 
IUGR
PTB
still birth
neonatal death
bone and teeth abnormalities

infant: snuffles, cataracts, excoriated mouth, rash around mouth and anus

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69
Q

nursing interventions w/ sphyllis

A

testing initially and repeated in third trimester

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70
Q

GBS tx

A

vaginal/anal swab at 35-37 weeks

intrapartal antibiotics: PCN, ampicillin

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71
Q

s/s of GBS

A

asymptomatic

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72
Q

risks w/ GBS

A

UTI
miscarriage, PTB, stillbirth, fetal death
endometritis, chorioamniotis
puerperal sepsis
early fetal onset: sepsis, RDS, pneumonia, meningitis
late fetal onset: meningitis

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73
Q

nursing interventions GBS

A

identify women at risk, instruct women to inform L&D
limit vaginal exam
standard precautions

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74
Q

chlamydia

A

most common bacterial sTI - spread through anal, vaginal and oral sex - carried in pre-cum
neonate infected during birth process

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75
Q

chlamydia tx

A

endocervical culture, antigen detection
azithromycin, amox, doxycycline
treat sexual partner!

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76
Q

chlamydia s/s

A 
asymptomatic
mucopurulent (green/yellow) discharge, lower abdominal pain, burning and frequency of urination, friable cervix
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77
Q

chlamydia risks

A 
PID
infertility
ectopic preg
increased risk for HIV
fetal: prematurity, conjunctivitis, pneumonia
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78
Q

nursing interventions w/ chlamydia

A

screen all sexually active 20-25 year olds
screen all pregnant women
abstain from sex or 7 days while being treated
erythromycin ointment to neonates within 2 hours
all medications as prescribed
rescreen 3 weeks after regimen

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79
Q

Does gonorrhea infect the neonate during the birthing process

A

Yes

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80
Q

gonorrhea tx

A

endocervical culture
ceftriaxone IM plus azithromycin OR plus doxycycline
azithromycin PO
treat sexual partner!

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81
Q

gonorrhea s/s

A 
asymptomatic
greenish-yellow vaginal discharge
dysuria
urinary frequency
bilateral lower abdominal or pelvic pain
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82
Q

risks w/ gonorrhea

A

PID
remains localized in urethra and cervix until ROM
ophthalmis neonatorum

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83
Q

nursing interventions w/ gonorrhea

A

screen all pregnant women at least once
abstain for 7 days
erythromycin ointment to neonates within 2 hours
rescreen 3 months after treatment

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84
Q

PID cause

A

ascending infection from vaginal and endocervix to the endometrium and fallopian tubes

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85
Q

s/s of PID

A 
bilateral sharp, cramping pain in lower quadrants
fever
mucopurulent discharge
N/V
abdominal tenderness
painful sex

*can also be asymptomatic

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86
Q

nursing interventions PID

A

partners need to be treated

IUD doesn’t need to be removed

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87
Q

toxoplasmosis background

A

cats feces, raw or undercooked meat, unpasteruized goat’s milk

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88
Q

toxoplasmosis diagnosis and tx

A

IgM and IgG antibody tests to diagnose
amnio to confirm
sulfadiazine (might harm fetus) and pyrimethamine (tertatogen)

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89
Q

s/s of toxoplasmosis

A

asymptomatic

mono

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90
Q

maternal/fetal risks with toxoplasmosis

A

miscarrage during 1st trimester
still birth
birth of child w/ clinical disease, encephalitis, microcephaly, retinochoroiditis
survivors = more often blind, deaf w/ severe mental function damage

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91
Q

trichomoniasis

A

protozoan in alkaline env

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92
Q

tx and diagnosis for trichomoniasis

A

elevated ph, positive whiff test
flagyl or metronidazole

treat both partners!

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93
Q

s/s of trichomoniasis

A

asymptomatic
green/grey itchy discharge
odor
dysuria

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94
Q

risks with trich

A

HIV more easily transmitted
PROM
PTL
LBW

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95
Q

nursing interventions with trich

A

avoid alcohol w/ meds

avoid sex for 7 days

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96
Q

crab lice and scabies - where does it come from

A

shared towels, bed linens and sexual contact

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97
Q

tx for crab lice and scabies

A

permethrin cream to hair, wash after 12 hours or as pill

treat partners and family
wash all linens

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98
Q

s/s of crab lice and scabies

A

itching

scabies: erythematous, popular lesions or furrows, itching is worse at night

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99
Q

candidiasis = yeast infection - cause

A 
antibiotics
OC or immunosuppressants
pregnancy
DM increased risk
changing vaginal flora
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100
Q

tx for candidiasis

A

topically applied ‘azole drugs

treatment of male partners not necessary

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101
Q

s/s of candidiasis

A 
cottage cheese discharge
no odor (normal ph)
itching
swollen labia
painful sex
pain with urination

male: penal rash, itching, swelling,
infants: thrush

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102
Q

nursing interventions candidasis

A

education

probiotics

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103
Q

hep B background

A

one of five strands

chronic

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104
Q

tx for hep b

A

test all pregnant women

newborn vaccination

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105
Q

s/s of hep b

A 
jaundice
anorexia
n/v
malaise
fever
arthritis (B, C , D)
chronic liver disease
liver cancer
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106
Q

When should hep b positive moms get immune globulin

A

w/i 12 hours of birth of newborn

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107
Q

How is parvovirus transmitted and when is the greatest risk during pregnancy?

A

transmitted via hand to hand contact or droplets

most severe if infection occurs before 20 weeks gestation

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108
Q

parvovirus: what do newborns need to be assessed for?

A

weekly measurements of peak systolic velocity of the middle cerebral artery to detect signs of fetal anemia (transfusion)

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109
Q

s/s of parvovirus

A

myalgia
inflammation of nasal membranes, headache, fever, nausea
slapped cheek rash on face
miscarriage, fetal hydrops, stillbirth, fetal anemia

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110
Q

When is the greatest risk for rubella?

A

1st trimester

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111
Q

rubella s/s

A

asymptomatic

newborn: cataracts, sensorineural deafness, congenital heart defects, CP

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112
Q

rubella nursing interventions

A

vaccinate

avoid pregnancy for 3 months after vaccine

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113
Q

What is the most common congenital infection?

A

CMV

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114
Q

How is CMV diagnosed?

A

cmv in maternal urine

rise in IgM levels

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115
Q

T/F: CMV is asymptomatic

A

True: asymptomatic

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116
Q

maternal/fetal risks w/ CMV

A 
10% of newborns have abnormalities
hearing loss
IUGR/SGA
microcephaly
hydrocephaly
CP
intellectual disability
anemia
hyperbili
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117
Q

herpes transmission

A

active primary genital HSV lesion and non-active lesion risk transmitting infection to newborn
can be spread by touch

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118
Q

tx for herpes

A

acyclovir, famciclovir, and valacyclovir

C section is recommended for active lesions

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119
Q

s/s of herpes

A

painful lesions in genital area that heal in 2-4 weeks

recurrence w/ stress, menstruation, ovulation, pregnancy and sex

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120
Q

herpes maternal/fetal risk

Very similar to CMV!

A 
SAB, LBW, PTB
10% of newborns infected have abnormalities
hearing loss
SGA/IUGR
microcephaly
hydrocephaly
CP
mentally disabled
anemia
hyperbili
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121
Q

nursing w/ herpes

A

education: clean, dry, loose clothing, sitz bath, cotton underwear

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122
Q

condylomata

A

genital warts, caused by HPV 6 and 11

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123
Q

tx for condylomata

A

biopsies, gels or creams, cryotherapy

partners don’t require tx!

124
Q

s/s of condylomata

A

asymptomatic

single or multiple soft, graying pink, cauliflower like lesions

125
Q

Which vaccine can prevent condylomata?

A

HPV vaccine

girls and boys 11-12 years or age or 13-26 year olds

126
Q

How is HIV spread (3)?

A

acquired through IV drug use, sex w/ infected partner, contaminated blood/fluid (breast milk)

127
Q

tx for HIV

A

ART for life
risk of transmitting HIV drops from 25-1% with ART during pregnancy
vaginal ring dapirivine HIV prevention

128
Q

risks w/ HIV (6)

A 
amenorrhea
early menopause
miscarriage
reduced fertility
PTL/PTD 
IUGR
129
Q

nursing interventions w/ HIV

A

opt out testing: early adulthood, first prenatal visit, retest in 3rd trimester, rapid testing labor
do not go on and off meds
check CD4 and VL count throughout pregnancy
give IV AZT to mom in labor on time w/ ART
avoid CVS, cerclage, amnio, AROM, FSE, SVE
hep B vaccine, flu and pneumoia
PP infection - poor healing
newborns: bathe asap, ART w/i 2 hours, PCR test must be done

130
Q

covid 19 fetal risk

A

PTB
uncommon in newborns with + mothers
no risk with breastfeeding

131
Q

nursing interventions w/ covid

A

vaccines effects on fetus are unclear but offer protection

benefits outweigh risks

132
Q

predictable risk factors for newborns

A
  • low SES of mother and limited access to health care
  • exposure to environmental dangers
  • preexisting maternal conditions
  • maternal factors (i.e. age)
  • medical conditions r/t pregnancy and complications
133
Q

SGA percentile

A

below 10th percentile

134
Q

LGA percentile

A

above 90th percentile

135
Q

symmetric (proportional) IUGR

A

caused by long term maternal conditions(smoking, high BP, viral, malnutritions, fetal abnormalities)

will always be small for age!

136
Q

asymmetrical IUGR

A

disproportional
associated with acute compromise of uteroplacental blood flow, preeclampsia, poor weight gain

might catch up once in optimal environment!

137
Q

SGA risk factors: symmetrical (6)

A 
smoking, 
substance abuse
high BP, 
severe malnutrition, 
chronic intrauterine viral infection, 
fetal genetic abnormalities,
138
Q

SGA risk factors: asymmetric

A

placental infarcts,
preeclampsia,
poor weight gain in pregnancy

139
Q

how to diagnose & confirm SGA

A

diagnose w/ fundal measurement and confirmed with sonogram

140
Q

how to manage SGA during pregnancy

A

serial nonstress testing (NST) weekly
serial biophysical profiles
lab assessment - CBC, glucose, cultures for CMV, GBS, toxicology screen for mother, TORCH titer

141
Q

SGA potential problems

A
  • can increase risk for neonatal mortality w/i first 28 days of life
  • perinatal asphyxia
  • hypothermia d/t large body surface, lack of SQ tissue and limited brown fat
  • hypoglycemia d/t increase in metabolic rate in response to heat loss and poor glycogen stores
  • polycythemia - increased number of RBCs d/t in utero chronic hypoxic stress
142
Q

SGA nursing care

A

monitor VS; observe for signs of respiratory distress
daily weights - assess for changes
keep baby warm w/ radiant warmer and polyethylene wrap
screen for hypoglycemia = most common complication

143
Q

s/s of newborn hypoglycemia and glucose level

A

jitteriness, lethargy, poor suck reflex

less than 40 mg/dl plasma glucose level

144
Q

LGA manifestations

A
  • body size usually proportional
  • macrosomic infant has poor motor skills and more difficulty regulating behavioral states

-EDD may have been miscalculated

145
Q

most common risk factor for LGA

A

most common cause is infant of an uncontrolled gestational diabetic and DM mother

146
Q

other LGA risk factors (2) (baby)

A
  • infants w/ transposition of the great vessels

- Beckwith-Wiedemann syndrome

147
Q

LGA mgmt during pregnancy

A

NST
serial biophysical profiles
glucose tolerance tests/monitor blood glucose
birth plans
education - mom’s diet, what to expect after birth

148
Q

LGA potential problems

A
  • birth trauma - fractured clavicle, Erb-Duchenne paralysis secondary to shoulder dystocia
  • hypoglycemia
  • polycythemia and/or hyperviscosity
  • if preterm LGA: RDS
  • postterm LGA: meconium aspiration
149
Q

LGA nursing care

A

monitor VS, observe for signs of resp distress
monitor weight
assess for birth trauma
screen for hypoglycemia (jitteriness, lethargy, poor suck reflex)
infant should be fed immediately after birth

150
Q

postmaturity syndrome

A

born after 42 weeks
most often due to inaccurate EDD
can be SGA, AGA or LGA

151
Q

postmaturity risks for baby (8)

A
  • dystocia
  • fetal distress during labor
  • meconium aspiration
  • decreased amniotic fluid
  • hypoglycemia from nutritional deprivation and depleted glycogen stores
  • polycythemia caused by increased production of RBCs in response to hypoxia
  • congenital anomalies
  • cold stress
152
Q

postmaturity nursing care

A

monitor closely during labor for fetal distress
hypothermia at birth
hypoglycemia - freq blood glucose monitoring and initiate early feeding
polycythemia
meconinum aspiration -> suction/ ECMO
RDS

153
Q

preterm (premature) newborn - how common?

A

1 in 10 births

154
Q

premature: respiratory

A
  • insufficient surfactant: alveoli collapse with each expiration
  • inadequate number and maturity of alveoli makes adequate alveolar gas exchange difficult
  • RDS
  • signs of resp distress typically develop w/i 1-2 hours after birth
155
Q

nursing interventions for premature respiratory

A 
assess respirations
oxygen saturation
administer oxygen
monitor for resp distress
suction available
156
Q

premature: cardiac

A
  • incomplete mucus coat of pulmonary blood vessels
  • lowered pulmonary resistance increases left to right shunting
  • patent ductus arteriosus causes pulmonary congestion, increased resp effort, CO2 retention, and bounding femoral pulses, retractions
157
Q

nursing care premature: cardiac - how often should you take the apical heart rate

A

apical heart rate for one minute every 1-2 hours

158
Q

premature: thermoregulation (6)

A
  • lack of SQ fat to insulate body
  • large body surface area in proportion to body weight so more likely to lose heat faster
  • small muscle mass
  • absent sweat or shiver mechanism
  • increased insensible fluid loss
  • increased risk for hypothermia
159
Q

nursing care: premature thermoregulation

A

radiant warmer, isolette
warm equipment
dry immediately
assess temp (skin probe)

160
Q

premature: immunological

A

lack of immunoglobulins from mother - cross placenta during third trimester
difficulty localizing infection and poor WBC response
increased risk of infection

161
Q

nursing care: premature immunological

A

monitor for sepsis
provide skin care
position changes to prevent skin breakdown

162
Q

premature: hematologic/hepatic

A
  • bruises easily r/t fragile capillaries and prolonged pro thrombin time
  • hyperbilirubinemia r/t immature liver and difficulty eliminating bilirubin released by normal breakdown of RBCs (jaundice)
  • hypoglycemia - decreased liver glycogen stores
  • prolonged drug metabolism r/t immature liver
  • immature production of clotting factors resulting in increased risk of bleeding disorders
163
Q

premature: GI/renal

A
  • aspiration d/t weak suck/swallow reflex until 33-34 weeks gestation, poor gag and cough reflexes
  • necrotizing enterocolitis (NEC)
  • unable to concentrate urine effectively increasing risk of dehydration
  • prolonged drug excretion time r/t immature kidneys
164
Q

necrotizing enterocolitis (NEC)

A

serious neonatal inflammation of intestines r/t immature GI system and hypoxia

165
Q

nursing care: premature GI/renal

A 
gavage feeds = tube feeds until suck or swallow reflex
can't breastfeed before 33-34 weeks
assess for distention/emesis/dehydration
I/O
daily weights
166
Q

premature: neuromuscular

A 
immature control of vital functions
increased risk of intraventricular hemorrhage
increased risk of apnea
poor muscle tone 
weak or absent reflexes
weak, feeble cry
167
Q

when is indicated for Mg for fetal neuroprotection (2)

A
  • active labor with cervical dilatation >= 4 cm w/ or w/o PPROM
  • planned preterm birth for fetal or maternal indications
168
Q

Betamethosone

A

2 (12.0 mg) doses q 24 hrs before birth

for surfactant

169
Q

surfactant delivery post birth

A

infasurf (calfactant)
administer w/i 30 mins of life!
given to gestations earlier than 29 weeks of age

170
Q

when to give respiratory syncytial virus vaccine for preterms

A

prior to dischrage

monthly during local RSV season

171
Q

do full terms get RSV vaccine

A

no

172
Q

when does swallow reflex start

A

35-36 weeks post conception age

when babies can have bottles

173
Q

bottle feedings

A

15-20 mins

.5-1 oz at a time

174
Q

breast feeding

A

Need a coordinated suck and swallow first
consistent weight gain
thermoregulates
cup

175
Q

gavage feedings - what do you need to check for before?

A

check for residual formula/breastmilk in stomach prior to feeding

176
Q

mother w/ controlled diabetes - what does it mean for infant

A

infants of mother w/ controlled diabetics prior to conception and throughout pregnancy have similar risk as infants of mothers w/o diabetes

177
Q

mother w/ uncontrolled diabetes - infant characteristics

A 
ruddy color
thick umbilical cord
large placenta
increased risk of c section
risk for LGA
178
Q

common complications of infants born to IDM

A
  • higher morbidity and mortality
  • usually LGA
  • hypoglycemia (<40 mg/dl; s/s 1-2 hours post birth)
  • hypocalcemia (tremors)
  • hyperbilirubinemia (48-72 hrs post birth)
  • birth trauma
  • polycythemia
  • RDS
  • congenital birth defects
179
Q

IDM nursing care

A

prenatally: control maternal glucose levels
monitor VS
observe for signs of resp distress
assess for birth trauma
screen for hypoglycemia
infant should be fed immediately after birth

180
Q

why do you feed newborns born to IDM moms immediately

A

after cord clamping, blood glucose levels fall and reach nadir 1-2 hours after birth
hepatic glycogen depleted if nursing is not established early

181
Q

when to screen for hypoglycemia for newborns born to IDM

A

hourly for 1st 4 hours then every 4 hours for 48 hours

182
Q

RDS (hyaline membrane disease) - cause

A

results from deficient/ineffective surfactant

183
Q

when does RDS appear

A

usually appears during first 24-48 hours; peaks at 72

184
Q

RDS predisposing factors

A

fetal hypoxia

postnatal hypothermia

185
Q

RDS interventions

A

keep warm after birth
chronic fetal stress –> can lead to surfactant production
can be related to BPD

186
Q

risk factors for retinopathy of prematurity

A

complication of RDS
-prolonged exposure to high concentrations of O2 may cause hemorrhage within retina and lead to retinal detachment and loss of vision
Other: intraventricular hemorrhage, chronic lung disease, apnea, hypoxia, sepsis, acidosis, multiple gestation, exposure to bright lights, blood transfusions

187
Q

tx for retinopathy of prematurity (ROP)

A

laser or surgical therapy to reattach retina

ophthalmologist screening

188
Q

intraventricular hemorrhage

A

complication of RDS

  • rupture of thin, fragile capillaries within ventricles of the brain leading to increased intracranial pressure
  • occurs most often in infants less than 1500 grams w/i 72 hours of birth
189
Q

risk factors for IVH

A

prematurity and hypoxia

190
Q

assessment for IVH

A

neurologic changes - hypotonia and lethargy, bulging fontanelles, increasing OFC, bradycardia, apnea and head circumference

or sometimes there are no symptoms: falling Hct, difficulty maintaining temp

191
Q

bronchopulmonary dysplasia (BPD)

A

chronic lung disease - lungs stiff, scarred, poor O2 exchange
requires mechanical ventilation but can also be a complication of mechanical ventilation

192
Q

O2 therapy support for BPD

A 
high frequency ventilation
patient triggered ventilation
CPAP
inhaled surfactant
inhaled nitric oxide
193
Q

AE of CPAP

A

nares become excoriated (skin breakdown)

septum disappears but will grow back

194
Q

tx for BPD and side effects of tx

A

corticosteroids to decrease inflammation and heal lungs
large dose tapered over several weeks
successful results but may have a range of long term side effects from asthma to lung fibrosis

195
Q

pulmonary interstitial emphysema

A

overdistention and rupture of distal airways which allows air to leak into connective tissues
clinical signs - increased O2 requirements, increased CO2 retention

196
Q

pneumothorax

A

aveolar rupture from overdistention

197
Q

s/s of pneumothorax

A

barrel-shaped chest, diminished breast sounds on affected side
grunting, cyanosis, tachypnea, retractions, O2 desaturation, hypotension, bradycardia
mgmt with needle aspiration

198
Q

necrotizing enterocolitis (NEC)

A

decreased blood flow and perfusion to intestines b/c hypoxia and hypoxemia at birth; cannot resist bacteria

199
Q

NEC assessment (5)

A 
abdominal distension
poor feeding
vomiting
blood in stool
decreased bowel sounds
200
Q

NEC tx

A 
NPO
IV fluids
parenteral TPN
antibiotics until intestines are healed
colostomy
breastmilk warmed
maternal swab for colonization of newborn gut
201
Q

meconinum aspiration

A

d/t stress in uterus
color of amniotic fluid will be green, yellow
can lead to RDS at birth

202
Q

nursing interventions for meconium aspiration

A

have low pressure wall suction available
possible surfactant therapy
maintain adequate oxygenation, ventilation and thermoreg

203
Q

apnea

A

cessation of breathing for 20 seconds or longer OR for less than 20 seconds w/ cyanosis, pallor and bradycardia
bradycardia usually follows apnea!

204
Q

tx for apnea

A

stimulate respirations w/ gentle tactile stimulation first

if unsuccessful, reposition neonate and support respirations w/ manual resuscitation bag if necessary

205
Q

hyperbilirubinemia - physiologic: when does it appear and what is the cause?

A

benign
never seen during first 24 hours, usually appears by 3rd day
d/t immature liver that cannot manage additional RBCs at birth or RBCs from bruising d/t traumatic birth

206
Q

pathologic hyperbili: when does it appear and what can be the cause?

A

before 24 hours and persistent after day 7
severe bruising can be d/t blood dyscrasia
ABO and Rh incompatibility –> leads to anemia
can be d/t infection

207
Q

kernicterus

A

bilirubin of 25 mg/dl or more stains brains cells, causes brain cell death, CP and epilepsy

208
Q

Who gets cord bili blood testing?

A

for all preemies

209
Q

nursing care for hyperbili

A

check mom’s Rh status –> rhogam w/i 72 hrs of birth
phototherapy
frequent feedings to clear bili
IV albumin, IGG or IGM to help excrete bili
blood exchange transfusion - 3cc in and out
bilimeterus
check coombs test

210
Q

at what age should children have appropriate names for body parts

A

4-5 years

211
Q

how often should you have CBE 18-40?

A

q3 years

212
Q

how often should you have CBE 40-65 yo?

A

annually

213
Q

how often should you have mammograms 45+

A

annual

214
Q

over 30, how often should you have PAP/HPV test?

A

PAP q 3 years

HPV q 5 years

215
Q

what age does colorectal cancer screening begin

A

46

216
Q

what age do you discontinue mammograms and colorectal screening

A

75

217
Q

how to assist pts in self-discovery in the growing years (6-18)

A

vulvar and breast self assessments
understand physiology
discuss kegels
know normal vaginal mucous/ fluid

218
Q

cycle length of menarche

A

lasts from first day of one menses to first day of the next

28-30 days (can vary from 21-35)

219
Q

what would indicate an abnormal cycle

A

blood flow of greater than 80 ml/cycle

220
Q

how often should you change pads during period

A

3-5 hours

should assess if supersaturates a maxipad every 1-2 hours for 2-3 days

221
Q

how often should you change tampons

A

3-6 hours
avoid super tampons
wash hands pre and post

222
Q

TSS - cause

A

staph auereus

etiology: non removal of tampons, diaphragms, cervical caps

223
Q

s/s of TSS

A 
fever, low BP, body rash, NVD
severe myalgia
inflamed vaginal mucous membranes
elevated BUN and liver function tests
low platelets
224
Q

how to treat TSS

A

IV antibiotic and vasopressors

225
Q

primary amenorrhea

A

no menses by 16 or w/in 4 years of breast development

226
Q

secondary amenorrhea

A

menses established for >3 months and then ceases

227
Q

how to examine/test amenorrhea

A

pelvic exam
MRI
serum prolactin (low or high), fSH (elevated, TSH levels (can lead to primary)

228
Q

dysmenorrhea causes

A

can be primary or secondary

endometriosis, PID, cervical stenosis, uterine fibroids, ovarian cysts, tumors, IUD

229
Q

how to treat PMS

A

restrict alcohol, chocolate, caffeine, nicotine, animal fats, salt and sugar
aerobic exercise, COC, NSAIDs
vitamin B6 (50-100 mg daily), calcium (1200 mg daily), Mag (400mg daily), vitamin E (400 units)
black cohosh, ginger, red raspberry leaf, evening primose oil, soy

230
Q

what can lead to elective terminations

A

a failure of fertility mgmt or contraception

lack of knowledge or access to BC

231
Q

vacuum aspiration

A

up to 13 weeks

outpatient, light anesthesia, 10-15 mins

232
Q

D&C

A

13-22 weeks
inpatient
deep anesthesia

233
Q

laminaria

A

medical abortion

insert into vagina, herb that dilates cervix and causes cramping

234
Q

methotrexate IM injections

A

medical abortion

halts embryo growth

235
Q

Misoprostol vaginal suppository: what is it used for and how long does it take

A

in 5-7 days causes uterine contraction

medical abortion

236
Q

when can medical abortions be done

A

before 9 weeks

237
Q

RU486 - when can you take

A

70 days after 1st day of last LMP

238
Q

what is RU486

A

2 drug procedure
1.mifepristone to block progesterone (3 pills)
2. methothrexate + misoprostol - 36-48 hours later to cause contractions
return to check in 2 weeks

239
Q

AE of RU486

A 
N/V/D
headaches
bleeding
cramping
hot flashes
mouth sores
240
Q

BSA

A

breast self awareness

know what is normal

241
Q

HPV vaccine

A

to prevent HPV and gential herpes
3 injections over 6 months
gardisil

242
Q

for multiple sexual partners, how often should gyn screening occur

A

every 3 months

243
Q

gyn history

A 
menarche
menstrual pattern
PMS and dysmenorrhea
sexual history and risks
pregnancy/contraception
medical/surgical history
244
Q

GYN exam

A

general health physical exam
CBE
abdominal palpation for uterus and ovaries
internal speculum exam to visualize cervix
bi-manual exam to assess ovaries/masses
rectal exam-guiac test for GI bleeding

245
Q

endometriosis

A

tissue grows outside of the uterus
b/w 20-45 years of age
pelvic pain, painful intercourse, infertility

246
Q

tx for endometriosis

A

combined OCs, progestins, testosterone, GnRH analogs

247
Q

how to dx endometriosis

A

laparoscopy

248
Q

endometriosis tx

A

tissue removal w/ laser

hysterectomy = severe cases

249
Q

PCOS: s/s

A

7% incidence

  • menstrual irregularities
  • hyperandrogenism
  • obesity
  • hyperinsulinemia
  • infertility
  • depression
250
Q

tx PCOS

A

oral contraceptives to help regulate hormones and menses

251
Q

ovarian cancer: how common and what are the signs

A

5th most common cancer in women
no screening tool!
mimics GI and bladder disorders - bloating fullness, pelvic/GI discomfort, pain that doesn’t fluctuate and lasts for more than 3 weeks, dysfunctional vaginal bleeding

252
Q

risk factors for ovarian cancer

A

age, hx of breast cancer, BRCA 1/2 and family history

253
Q

endometrial cancer: signs

A

slow growing

abdominal bleeding post menopause, vaginal discharge, enlarged uterus

254
Q

risks for endometrial cancer

A 
ERT
nulliparity
PCOS
late menopause
HTN
DM
255
Q

cervical cancer: signs

A

slow growing
painless vaginal postmenstrual and post coital bleeding
foul smelling discharge
pelvic pain

256
Q

risks for cervical cancer

A

HPV
early first sex
smoking
multiple sex partners

257
Q

cervical screening/tx

A 
Bethesda system
colposcopy
LEEP
cryosurgery
laser
conization - remove cone of cervix
258
Q

causes of pelvic floor issues

A

cystocele - bulge of bladder into uterus
rectocele - condition in which the tissue wall b/w rectum and vagina weakens
uterine prolapse

259
Q

rectocele

A

rectum blaoons into vagina

260
Q

uterine prolapse: cause and s/s

A

d/t trauma of pregnancy

manifests as dragging sensation in groin and backache over sacrum

261
Q

cause of cystocele and how to tx

A

wall b/w bladder and vagina weakens
bladder in anterior vagina
stress incontinence
tx: kegels, vaginal pessary or rings

262
Q

what can contribute to benign breast disorder

A

caffeine
chocolate
tobacco

263
Q

malignant breast disease: prevalence

A

1 in 8

mostly occurs over age 50

264
Q

menopause

A

absence of menses for 1 full year
usually b/w 45-58
estrogen levels drop

265
Q

perimenopause

A

menstrual irregularities
duration of 5-8 years
decreased libido, vaginal lubrication
pregnancy can still be an issue

266
Q

menopause characteristics

A 
endometrium thins, breast atrophies
increased vaginal infections b/c of decreased secretions
pubic hair thins
hot flashes
psychological ajdustement
osteoporosis
CV risk b/c decreased HDL levels
lack of sleep
267
Q

hormone therapy for menopause

A
  • estrogen therapy (only for women w/ hysterectomy)
  • estrogen/progesterone therapy
  • oral, transdermal, gel, lotion, mist, cream, vaginal ring
  • adding testosterone may help with decreased libido
268
Q

complementary therapy for menopause

A

isoflavone (soy) - estrogen like qualities, do not use if a cancer history
black cohosh, red clover, ginseng, kava, DHEA

269
Q

osteoporosis risk factors

A

family hx

decreased estrogen levels

270
Q

osteoporosis prevention

A 
Ca and Vit. D
weights and balance training
no smoking
moderate alcohol
fall prevention
full range of meds!
271
Q

hysterectomy

A

remove all repro organs

272
Q

dilation and curettage

A

scrape uterus

273
Q

uterine abalation

A

used for excessive blood loss

remove endometrial lining

274
Q

saplingectomy

A

remove tubes

can be tx for ectopic preg

275
Q

oophorectomy

A

remove ovaries

276
Q

vulvectomy

A

remove labia, clitoris, etc.

can be for cancer or precancer

277
Q

causes of vulvar lesions

A

cancer
bartholin gland cyst (drainage, antibiotics)
lichen sclerosus (peri and post menopausal, tx with antihistamines)

278
Q

Cycle of abuse

A
  1. Tension building phase
  2. Acute battering incident (violence)
  3. Tranquil phase (honeymoon phase)
279
Q

Characteristics of tranquil phase

A

If women is abused, women generally are not interested in seeking help but the batterer is more open to get help if offered

280
Q

When are abused party most likely to seek help

A

Acute battering violence phase

281
Q

Victim/survivor characteristics

A

May believe themselves to be subservient
Personal feeling of poor self worth
Co-dependency.- responsible for needs of others
Perception that abuse is the one in need they have a problem and need help

282
Q

Abuser characteristics

A 
Low self esteem
Insecure, powerlessness
Poor verbal skills
Problems with abandonment, intimacy
Loses temper easily
Unusual jealousy
Violence is acceptable
Rigid idea of male/female/partner roles
Substance abuse complications
283
Q

Elder abuse

A
  • Over age of 65
  • More women than men
  • Domestic abuse, institutional abuse, self neglect
284
Q

Other forms of abuse

A 
Stalking
Cyberstalking
Sexual harassment
Assault
Date rape
Homophobia
285
Q

Rape trauma syndrome acute phase

A

Shock, disbelief
Embarrassment
Wants revenge
Suppress emotions but may also cry, sleep disturbances

286
Q

Rape trauma syndrome: outward adjustment phase

A

Look composed outwardly
Might refuse to discuss
Might deny need for counseling
Might seek out security measures (i.e. self defense)

287
Q

Rape trauma syndrome: Reorganization

A

Emotional distancing
Risky sexual behaviors
Phobias
Nightmares
Urge to talk about or resolve feelings or can remain silent
Might cycle back b/w acute and outward adjustment phase

288
Q

Rape trauma syndrome: integration and recovery

A

Safe
Know to blame assailant
Advocacy stage
Might relapse (not linear)

289
Q

Strategies to decrease violence

A

Education: build healthy relationships, parenting classes
Identify families at risk
Support groups
Improve self worth
Communication action
Law/policy - violence against women act of 1994

290
Q

Nursing plan: violence

A 
Open body language
Acknowledge and support
Focus on strengths
Avoid blame
Be patient
Assist in problem identification and viable solutions
Assist with an exit plan
Do not pressure
Do not put at increased risk
291
Q

Inequality

A

Unequal access to opportunities

292
Q

Equality

A

Evenly distributed tools and assistance

293
Q

Equity

A

Custom tools that identify and address inequality

294
Q

Justice

A

Fixing the system to offer equal access to both tools and opportunities

295
Q

what % of women are carriers of GBS

A

10-40%

296
Q

what can GBS lead to

A

endometritis, amniotis, UTI

297
Q

how do you get GBS

A

during birth process or through ascending genital tract infection

298
Q

How is CMV transmitted

A

birth process or placenta or breastmilk and saliva

299
Q

What does UTIs increase the risk for as it relates to birth?

A

increased risk for premature birth, IUGR

300
Q

Is breastfeeding contraindicated with a herpes lesion

A

breastfeeding = CI w/ breast lesion

301
Q

When is a C section not indicated for HIV infected mom

A

C section not indicated for RNA < 1000 copies

302
Q

Characteristics of moms with LGA babies

A

-mothers of LGA babies tend to be heavier, taller, older and of greater parity

303
Q

Concerns with post maturity syndrome

A

mortality rate is 2-3 x higher than for term infants
decreased placental function impairs oxygenation and nutrition transport
placenta ages and calcifies

304
Q

Hyperbili: erythroblastosis fetalis

A

Increase in immature RBCS

Pathologic

305
Q

Hyperbili: hydros fetalis

A

Pathological
Destruction of RBCS
Severe anemia - could lead to death

Mother Baby (3 decks)

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