Final Third of Class Flashcards
what is the single most dangerous event in a lifetime for a female
pregnancy
medical uses of contraception (beyond preventing pregnancy)
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
least effective method of contraception
fertility awareness based d/t user error and complications
symptothermal
calendar/mucus/body temp/standard
what causes increase temp during ovulation
usually spike during ovulation d/t increased progesterone
use contraception that day and 3 days after
billings (mucus)
before ovulation - clear, water, stretchy (estrogen dominant)
thick, white and sticky when not fertile (spinnbarkeit)
Standard method: if you have a regular cycle (26-32).. when to avoid sex
days 8-19
calendar rhythm method
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
barrier methods
second least effective
prevent sperm from entering uterine cavity
d/t user error and inconvenience
types of barrier methods
condoms (male and female)
contracetpive sponge
cervical cap
diaphragm
contraceptive sponge
moisten sponge with water
leave in place for 6-8 hours post coital (less than 24 hours)
What to avoid with condoms (3)?
avoid oil based lubricants, monistat, estrogen creams
Also female condom can be inserted 8 hours prior to coitus
diaphragm
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
cervical cap
requires fitting
requires spermicide
leave in place for 6-8 hours post coital (no more than 48 hours)
spermicide risk
vaginal walls become more susceptible to HIV
hormonal methods
COC
vaginal ring
progestin minipill
patch
what pill do you use while breasfeeding
minipill = progestin only
COC pills
estrogen and progestin
extended use - 4 years
contraindicated with smokers
patch
weekly application for 3 weeks
slight risk of thromboembolism
vaginal ring
nuva ring
inserted for 3 weeks and removed for 7 days
depo-provera
progestin only
injected every 3 months
long-acting reversible (LARC)
intraueterine
nexplanon
IUD
Copper - 10 years - non hormonal
Progesterone - Mirena (5 yrs), Skyla (3 yrs), Liletta (3 yrs), Kyleena (3 years)
nexplanon
sits under skin progestin good for only 3 years prevents ovulation, thickens mucus AE: weight gain, headaches, irregular menses, acne
most effective method of contraception
operative sterilization = vasectomy and tubal ligation
after getting vasectomy, how long does it take to clear remaining sperm?
3 months
15-20 ejaculations
*no effect on sexual function
post coital contraception
sooner taken, the more likely it’ll work (within 12 hours)
unlikely to prevent implantation
AE of post coital contraception
nausea, HA, irregular bleeding
what post coital contraception works by inhibiting or delaying contraception
plan B (w/i 72 hours) - progestin only - interferes with ovulation
ella (w/i 5 days) - progesterone modulator
yutze method - combined progestin-estrogen pill
what post coital contraception prevents fertilization
paraguard (within 5 days) - copper IUD
may affect oocyte and endometrium
pregnancy
implantation in the uterine wall of a fertizlied ovum, most fertilized eggs naturally fail to implant
What are the three things contraception can block to prevent pregnancy
interference with ovulation, fertilization or implantation
abortion
ends an established pregnancy after implantation
miscarriage and therapeutic
hormonal contraception
use estrogen/progestone to prevent ovulation and thicken cerivcal mucus
do LARCs, plan B and Ella disrupt existing pregnancies
no
plan b and ella work by preventing ovulation
t/f: hormonal and copper IUDs work by preventing sperm from reaching and fertilizing an egg
true - copper IUD can prevent implantation of a fertilized egg
TORCH
Toxicplasmosis Other - hep, sphyllis, Zika, HIV, parvovirus Rubella CMV Herpes
down syndrome
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
fetal alcohol syndrome
epicanthal folds strabismus ptosis poor suck small teeth abnormal palmar creases irregular hair heart defects
what could be signs of congenital heart defect
cyanosis within 12-24 hours of birth but normal respiratory signs
could be a sign of cardiac issues like ductal dependent lesions
choanal atresia
unilateral or bilateral occlusion of posterior nares
bone is blocking 1 or 2 nasal passages
cleft palate/lip
cleft palate = opening on roof of mouth
cleft lip = extends from roof of mouth into lip and nasal passage
un-repaired trachea espohageal fistula
fistula b/w trachea and esophagus below normal openings to esophagus and trachea
and upper part of esophagus dead ends
congenital diaphragmatic hernia pre surgical repair
open in diaphragm wall - food contents can go up into chest cavity
choanal atresia assessment
cyanosis, retractions, noisy respirations, difficulty breathing during feeding
choanal atresia nursing interventions
assess patency of nares assist with passing nasal catheter obtain ENT consult maintain resp function head elevation
cleft palate/lip assessment: what do they swallow a lot of
swallow a lot of air - opening b/w nasal passage and mouth
cleft lip and palate interventions
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
un-repaired trachea espohageal fistula assessment
excessive drooling
abdominal distension
periodic chocking
cyanotic episodes
un-repaired trachea espohageal fistula nursing
prevent aspirations withhold feeding elevate head keep baby calm antibiotics low intermittent suction in pouch
congenital diaphragmatic hernia pre surgical repair assessment
gasping respirations nasal flaring chest retractions barrel chest scaphoid abdomen asymmetric chest expansion diminished/absent unilateral breath sounds
congenital diaphragmatic hernia pre surgical repair nursing interventions
prepare for intubation
high semi fowlers
turn to affected side - allows for more lung expansion
CPAP
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
CIs for CPAP
choanal atresia
cleft palate
un-repaired trachea esophageal fistula
congenital diaphragmatic hernia pre surgical repair
4 types of hyperbili
physiologic - benign
breastfeeding jaundice - benign - inadequate fluid intake, self limiting
breast milk jaundice - benign - issue with milk composition
pathologic
phototherapy is required when…
if bilirubin >20mg/dl
phototherapy steps
remove clothing cover eyes and check every 4 hours check VS every 4 hours cluster care no lotion reposition every 2 hours
bacterial vaginosis
most prevalent form of vaginal infection
a change in normal vaginal flora
avoid w/ loose cotton underwear, no perfumes in vaginal flora
treatment and diagnose: bacterial vaginosis
whiff test, absence of leukocytes
flagyl orally or flagyl/clindamycin cream (avoid alcohol with flagyl)
*partners do not need to be treated
s/s of bacterial vaginosis
asymptomatic
thin, watery white or grey discharge with odor
risks with bacterial vaginosis (7)
increased risk of:
- PID
- HIV
- PTB
- PROM
- LBW
- PTL
- PP endometritis
nursing interventions: bacterial vaginosis
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
tx for UTI
antibiotics
void when you need to!
empty bladder before and after sex
wipe from front to back
s/s of UTI
asymptomatic dysuria, urgency, frequency fever hematuria chills flank pain
nursing intervention for UTI
frequent screening and education
syphilis tx
test: VDRL (venereal disease research lab), RPR (rapid plasma antigen)
benzathine PCN G, Doxycycline/tetracycline
s/s of syphilis
chancre (4 weeks) followed by wartlike plaque for 6weeks - 6 months
slight fever
loss of weight
malaise
risks w/ syphilis
IUGR PTB still birth neonatal death bone and teeth abnormalities
infant: snuffles, cataracts, excoriated mouth, rash around mouth and anus
nursing interventions w/ sphyllis
testing initially and repeated in third trimester
GBS tx
vaginal/anal swab at 35-37 weeks
intrapartal antibiotics: PCN, ampicillin
s/s of GBS
asymptomatic
risks w/ GBS
UTI
miscarriage, PTB, stillbirth, fetal death
endometritis, chorioamniotis
puerperal sepsis
early fetal onset: sepsis, RDS, pneumonia, meningitis
late fetal onset: meningitis
nursing interventions GBS
identify women at risk, instruct women to inform L&D
limit vaginal exam
standard precautions
chlamydia
most common bacterial sTI - spread through anal, vaginal and oral sex - carried in pre-cum
neonate infected during birth process
chlamydia tx
endocervical culture, antigen detection
azithromycin, amox, doxycycline
treat sexual partner!
chlamydia s/s
asymptomatic mucopurulent (green/yellow) discharge, lower abdominal pain, burning and frequency of urination, friable cervix
chlamydia risks
PID infertility ectopic preg increased risk for HIV fetal: prematurity, conjunctivitis, pneumonia
nursing interventions w/ chlamydia
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
Does gonorrhea infect the neonate during the birthing process
Yes
gonorrhea tx
endocervical culture
ceftriaxone IM plus azithromycin OR plus doxycycline
azithromycin PO
treat sexual partner!
gonorrhea s/s
asymptomatic greenish-yellow vaginal discharge dysuria urinary frequency bilateral lower abdominal or pelvic pain
risks w/ gonorrhea
PID
remains localized in urethra and cervix until ROM
ophthalmis neonatorum
nursing interventions w/ gonorrhea
screen all pregnant women at least once
abstain for 7 days
erythromycin ointment to neonates within 2 hours
rescreen 3 months after treatment
PID cause
ascending infection from vaginal and endocervix to the endometrium and fallopian tubes
s/s of PID
bilateral sharp, cramping pain in lower quadrants fever mucopurulent discharge N/V abdominal tenderness painful sex
*can also be asymptomatic
nursing interventions PID
partners need to be treated
IUD doesn’t need to be removed
toxoplasmosis background
cats feces, raw or undercooked meat, unpasteruized goat’s milk
toxoplasmosis diagnosis and tx
IgM and IgG antibody tests to diagnose
amnio to confirm
sulfadiazine (might harm fetus) and pyrimethamine (tertatogen)
s/s of toxoplasmosis
asymptomatic
mono
maternal/fetal risks with toxoplasmosis
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
trichomoniasis
protozoan in alkaline env
tx and diagnosis for trichomoniasis
elevated ph, positive whiff test
flagyl or metronidazole
treat both partners!
s/s of trichomoniasis
asymptomatic
green/grey itchy discharge
odor
dysuria
risks with trich
HIV more easily transmitted
PROM
PTL
LBW
nursing interventions with trich
avoid alcohol w/ meds
avoid sex for 7 days
crab lice and scabies - where does it come from
shared towels, bed linens and sexual contact
tx for crab lice and scabies
permethrin cream to hair, wash after 12 hours or as pill
treat partners and family
wash all linens
s/s of crab lice and scabies
itching
scabies: erythematous, popular lesions or furrows, itching is worse at night
candidiasis = yeast infection - cause
antibiotics OC or immunosuppressants pregnancy DM increased risk changing vaginal flora
tx for candidiasis
topically applied ‘azole drugs
treatment of male partners not necessary
s/s of candidiasis
cottage cheese discharge no odor (normal ph) itching swollen labia painful sex pain with urination
male: penal rash, itching, swelling,
infants: thrush
nursing interventions candidasis
education
probiotics
hep B background
one of five strands
chronic
tx for hep b
test all pregnant women
newborn vaccination
s/s of hep b
jaundice anorexia n/v malaise fever arthritis (B, C , D) chronic liver disease liver cancer
When should hep b positive moms get immune globulin
w/i 12 hours of birth of newborn
How is parvovirus transmitted and when is the greatest risk during pregnancy?
transmitted via hand to hand contact or droplets
most severe if infection occurs before 20 weeks gestation
parvovirus: what do newborns need to be assessed for?
weekly measurements of peak systolic velocity of the middle cerebral artery to detect signs of fetal anemia (transfusion)
s/s of parvovirus
myalgia
inflammation of nasal membranes, headache, fever, nausea
slapped cheek rash on face
miscarriage, fetal hydrops, stillbirth, fetal anemia
When is the greatest risk for rubella?
1st trimester
rubella s/s
asymptomatic
newborn: cataracts, sensorineural deafness, congenital heart defects, CP
rubella nursing interventions
vaccinate
avoid pregnancy for 3 months after vaccine
What is the most common congenital infection?
CMV
How is CMV diagnosed?
cmv in maternal urine
rise in IgM levels
T/F: CMV is asymptomatic
True: asymptomatic
maternal/fetal risks w/ CMV
10% of newborns have abnormalities hearing loss IUGR/SGA microcephaly hydrocephaly CP intellectual disability anemia hyperbili
herpes transmission
active primary genital HSV lesion and non-active lesion risk transmitting infection to newborn
can be spread by touch
tx for herpes
acyclovir, famciclovir, and valacyclovir
C section is recommended for active lesions
s/s of herpes
painful lesions in genital area that heal in 2-4 weeks
recurrence w/ stress, menstruation, ovulation, pregnancy and sex
herpes maternal/fetal risk
Very similar to CMV!
SAB, LBW, PTB 10% of newborns infected have abnormalities hearing loss SGA/IUGR microcephaly hydrocephaly CP mentally disabled anemia hyperbili
nursing w/ herpes
education: clean, dry, loose clothing, sitz bath, cotton underwear
condylomata
genital warts, caused by HPV 6 and 11
tx for condylomata
biopsies, gels or creams, cryotherapy
partners don’t require tx!
s/s of condylomata
asymptomatic
single or multiple soft, graying pink, cauliflower like lesions
Which vaccine can prevent condylomata?
HPV vaccine
girls and boys 11-12 years or age or 13-26 year olds
How is HIV spread (3)?
acquired through IV drug use, sex w/ infected partner, contaminated blood/fluid (breast milk)
tx for HIV
ART for life
risk of transmitting HIV drops from 25-1% with ART during pregnancy
vaginal ring dapirivine HIV prevention
risks w/ HIV (6)
amenorrhea early menopause miscarriage reduced fertility PTL/PTD IUGR
nursing interventions w/ HIV
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
covid 19 fetal risk
PTB
uncommon in newborns with + mothers
no risk with breastfeeding
nursing interventions w/ covid
vaccines effects on fetus are unclear but offer protection
benefits outweigh risks
predictable risk factors for newborns
- 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
SGA percentile
below 10th percentile
LGA percentile
above 90th percentile
symmetric (proportional) IUGR
caused by long term maternal conditions(smoking, high BP, viral, malnutritions, fetal abnormalities)
will always be small for age!
asymmetrical IUGR
disproportional
associated with acute compromise of uteroplacental blood flow, preeclampsia, poor weight gain
might catch up once in optimal environment!
SGA risk factors: symmetrical (6)
smoking, substance abuse high BP, severe malnutrition, chronic intrauterine viral infection, fetal genetic abnormalities,
SGA risk factors: asymmetric
placental infarcts,
preeclampsia,
poor weight gain in pregnancy
how to diagnose & confirm SGA
diagnose w/ fundal measurement and confirmed with sonogram
how to manage SGA during pregnancy
serial nonstress testing (NST) weekly
serial biophysical profiles
lab assessment - CBC, glucose, cultures for CMV, GBS, toxicology screen for mother, TORCH titer
SGA potential problems
- 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
SGA nursing care
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
s/s of newborn hypoglycemia and glucose level
jitteriness, lethargy, poor suck reflex
less than 40 mg/dl plasma glucose level
LGA manifestations
- body size usually proportional
- macrosomic infant has poor motor skills and more difficulty regulating behavioral states
-EDD may have been miscalculated
most common risk factor for LGA
most common cause is infant of an uncontrolled gestational diabetic and DM mother
other LGA risk factors (2) (baby)
- infants w/ transposition of the great vessels
- Beckwith-Wiedemann syndrome
LGA mgmt during pregnancy
NST
serial biophysical profiles
glucose tolerance tests/monitor blood glucose
birth plans
education - mom’s diet, what to expect after birth
LGA potential problems
- birth trauma - fractured clavicle, Erb-Duchenne paralysis secondary to shoulder dystocia
- hypoglycemia
- polycythemia and/or hyperviscosity
- if preterm LGA: RDS
- postterm LGA: meconium aspiration
LGA nursing care
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
postmaturity syndrome
born after 42 weeks
most often due to inaccurate EDD
can be SGA, AGA or LGA
postmaturity risks for baby (8)
- 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
postmaturity nursing care
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
preterm (premature) newborn - how common?
1 in 10 births
premature: respiratory
- 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
nursing interventions for premature respiratory
assess respirations oxygen saturation administer oxygen monitor for resp distress suction available
premature: cardiac
- 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
nursing care premature: cardiac - how often should you take the apical heart rate
apical heart rate for one minute every 1-2 hours
premature: thermoregulation (6)
- 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
nursing care: premature thermoregulation
radiant warmer, isolette
warm equipment
dry immediately
assess temp (skin probe)
premature: immunological
lack of immunoglobulins from mother - cross placenta during third trimester
difficulty localizing infection and poor WBC response
increased risk of infection
nursing care: premature immunological
monitor for sepsis
provide skin care
position changes to prevent skin breakdown
premature: hematologic/hepatic
- 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
premature: GI/renal
- 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
necrotizing enterocolitis (NEC)
serious neonatal inflammation of intestines r/t immature GI system and hypoxia
nursing care: premature GI/renal
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
premature: neuromuscular
immature control of vital functions increased risk of intraventricular hemorrhage increased risk of apnea poor muscle tone weak or absent reflexes weak, feeble cry
when is indicated for Mg for fetal neuroprotection (2)
- active labor with cervical dilatation >= 4 cm w/ or w/o PPROM
- planned preterm birth for fetal or maternal indications
Betamethosone
2 (12.0 mg) doses q 24 hrs before birth
for surfactant
surfactant delivery post birth
infasurf (calfactant)
administer w/i 30 mins of life!
given to gestations earlier than 29 weeks of age
when to give respiratory syncytial virus vaccine for preterms
prior to dischrage
monthly during local RSV season
do full terms get RSV vaccine
no
when does swallow reflex start
35-36 weeks post conception age
when babies can have bottles
bottle feedings
15-20 mins
.5-1 oz at a time
breast feeding
Need a coordinated suck and swallow first
consistent weight gain
thermoregulates
cup
gavage feedings - what do you need to check for before?
check for residual formula/breastmilk in stomach prior to feeding
mother w/ controlled diabetes - what does it mean for infant
infants of mother w/ controlled diabetics prior to conception and throughout pregnancy have similar risk as infants of mothers w/o diabetes
mother w/ uncontrolled diabetes - infant characteristics
ruddy color thick umbilical cord large placenta increased risk of c section risk for LGA
common complications of infants born to IDM
- 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
IDM nursing care
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
why do you feed newborns born to IDM moms immediately
after cord clamping, blood glucose levels fall and reach nadir 1-2 hours after birth
hepatic glycogen depleted if nursing is not established early
when to screen for hypoglycemia for newborns born to IDM
hourly for 1st 4 hours then every 4 hours for 48 hours
RDS (hyaline membrane disease) - cause
results from deficient/ineffective surfactant
when does RDS appear
usually appears during first 24-48 hours; peaks at 72
RDS predisposing factors
fetal hypoxia
postnatal hypothermia
RDS interventions
keep warm after birth
chronic fetal stress –> can lead to surfactant production
can be related to BPD
risk factors for retinopathy of prematurity
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
tx for retinopathy of prematurity (ROP)
laser or surgical therapy to reattach retina
ophthalmologist screening
intraventricular hemorrhage
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
risk factors for IVH
prematurity and hypoxia
assessment for IVH
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
bronchopulmonary dysplasia (BPD)
chronic lung disease - lungs stiff, scarred, poor O2 exchange
requires mechanical ventilation but can also be a complication of mechanical ventilation
O2 therapy support for BPD
high frequency ventilation patient triggered ventilation CPAP inhaled surfactant inhaled nitric oxide
AE of CPAP
nares become excoriated (skin breakdown)
septum disappears but will grow back
tx for BPD and side effects of tx
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
pulmonary interstitial emphysema
overdistention and rupture of distal airways which allows air to leak into connective tissues
clinical signs - increased O2 requirements, increased CO2 retention
pneumothorax
aveolar rupture from overdistention
s/s of pneumothorax
barrel-shaped chest, diminished breast sounds on affected side
grunting, cyanosis, tachypnea, retractions, O2 desaturation, hypotension, bradycardia
mgmt with needle aspiration
necrotizing enterocolitis (NEC)
decreased blood flow and perfusion to intestines b/c hypoxia and hypoxemia at birth; cannot resist bacteria
NEC assessment (5)
abdominal distension poor feeding vomiting blood in stool decreased bowel sounds
NEC tx
NPO IV fluids parenteral TPN antibiotics until intestines are healed colostomy breastmilk warmed maternal swab for colonization of newborn gut
meconinum aspiration
d/t stress in uterus
color of amniotic fluid will be green, yellow
can lead to RDS at birth
nursing interventions for meconium aspiration
have low pressure wall suction available
possible surfactant therapy
maintain adequate oxygenation, ventilation and thermoreg
apnea
cessation of breathing for 20 seconds or longer OR for less than 20 seconds w/ cyanosis, pallor and bradycardia
bradycardia usually follows apnea!
tx for apnea
stimulate respirations w/ gentle tactile stimulation first
if unsuccessful, reposition neonate and support respirations w/ manual resuscitation bag if necessary
hyperbilirubinemia - physiologic: when does it appear and what is the cause?
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
pathologic hyperbili: when does it appear and what can be the cause?
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
kernicterus
bilirubin of 25 mg/dl or more stains brains cells, causes brain cell death, CP and epilepsy
Who gets cord bili blood testing?
for all preemies
nursing care for hyperbili
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
at what age should children have appropriate names for body parts
4-5 years
how often should you have CBE 18-40?
q3 years
how often should you have CBE 40-65 yo?
annually
how often should you have mammograms 45+
annual
over 30, how often should you have PAP/HPV test?
PAP q 3 years
HPV q 5 years
what age does colorectal cancer screening begin
46
what age do you discontinue mammograms and colorectal screening
75
how to assist pts in self-discovery in the growing years (6-18)
vulvar and breast self assessments
understand physiology
discuss kegels
know normal vaginal mucous/ fluid
cycle length of menarche
lasts from first day of one menses to first day of the next
28-30 days (can vary from 21-35)
what would indicate an abnormal cycle
blood flow of greater than 80 ml/cycle
how often should you change pads during period
3-5 hours
should assess if supersaturates a maxipad every 1-2 hours for 2-3 days
how often should you change tampons
3-6 hours
avoid super tampons
wash hands pre and post
TSS - cause
staph auereus
etiology: non removal of tampons, diaphragms, cervical caps
s/s of TSS
fever, low BP, body rash, NVD severe myalgia inflamed vaginal mucous membranes elevated BUN and liver function tests low platelets
how to treat TSS
IV antibiotic and vasopressors
primary amenorrhea
no menses by 16 or w/in 4 years of breast development
secondary amenorrhea
menses established for >3 months and then ceases
how to examine/test amenorrhea
pelvic exam
MRI
serum prolactin (low or high), fSH (elevated, TSH levels (can lead to primary)
dysmenorrhea causes
can be primary or secondary
endometriosis, PID, cervical stenosis, uterine fibroids, ovarian cysts, tumors, IUD
how to treat PMS
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
what can lead to elective terminations
a failure of fertility mgmt or contraception
lack of knowledge or access to BC
vacuum aspiration
up to 13 weeks
outpatient, light anesthesia, 10-15 mins
D&C
13-22 weeks
inpatient
deep anesthesia
laminaria
medical abortion
insert into vagina, herb that dilates cervix and causes cramping
methotrexate IM injections
medical abortion
halts embryo growth
Misoprostol vaginal suppository: what is it used for and how long does it take
in 5-7 days causes uterine contraction
medical abortion
when can medical abortions be done
before 9 weeks
RU486 - when can you take
70 days after 1st day of last LMP
what is RU486
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
AE of RU486
N/V/D headaches bleeding cramping hot flashes mouth sores
BSA
breast self awareness
know what is normal
HPV vaccine
to prevent HPV and gential herpes
3 injections over 6 months
gardisil
for multiple sexual partners, how often should gyn screening occur
every 3 months
gyn history
menarche menstrual pattern PMS and dysmenorrhea sexual history and risks pregnancy/contraception medical/surgical history
GYN exam
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
endometriosis
tissue grows outside of the uterus
b/w 20-45 years of age
pelvic pain, painful intercourse, infertility
tx for endometriosis
combined OCs, progestins, testosterone, GnRH analogs
how to dx endometriosis
laparoscopy
endometriosis tx
tissue removal w/ laser
hysterectomy = severe cases
PCOS: s/s
7% incidence
- menstrual irregularities
- hyperandrogenism
- obesity
- hyperinsulinemia
- infertility
- depression
tx PCOS
oral contraceptives to help regulate hormones and menses
ovarian cancer: how common and what are the signs
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
risk factors for ovarian cancer
age, hx of breast cancer, BRCA 1/2 and family history
endometrial cancer: signs
slow growing
abdominal bleeding post menopause, vaginal discharge, enlarged uterus
risks for endometrial cancer
ERT nulliparity PCOS late menopause HTN DM
cervical cancer: signs
slow growing
painless vaginal postmenstrual and post coital bleeding
foul smelling discharge
pelvic pain
risks for cervical cancer
HPV
early first sex
smoking
multiple sex partners
cervical screening/tx
Bethesda system colposcopy LEEP cryosurgery laser conization - remove cone of cervix
causes of pelvic floor issues
cystocele - bulge of bladder into uterus
rectocele - condition in which the tissue wall b/w rectum and vagina weakens
uterine prolapse
rectocele
rectum blaoons into vagina
uterine prolapse: cause and s/s
d/t trauma of pregnancy
manifests as dragging sensation in groin and backache over sacrum
cause of cystocele and how to tx
wall b/w bladder and vagina weakens
bladder in anterior vagina
stress incontinence
tx: kegels, vaginal pessary or rings
what can contribute to benign breast disorder
caffeine
chocolate
tobacco
malignant breast disease: prevalence
1 in 8
mostly occurs over age 50
menopause
absence of menses for 1 full year
usually b/w 45-58
estrogen levels drop
perimenopause
menstrual irregularities
duration of 5-8 years
decreased libido, vaginal lubrication
pregnancy can still be an issue
menopause characteristics
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
hormone therapy for menopause
- 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
complementary therapy for menopause
isoflavone (soy) - estrogen like qualities, do not use if a cancer history
black cohosh, red clover, ginseng, kava, DHEA
osteoporosis risk factors
family hx
decreased estrogen levels
osteoporosis prevention
Ca and Vit. D weights and balance training no smoking moderate alcohol fall prevention full range of meds!
hysterectomy
remove all repro organs
dilation and curettage
scrape uterus
uterine abalation
used for excessive blood loss
remove endometrial lining
saplingectomy
remove tubes
can be tx for ectopic preg
oophorectomy
remove ovaries
vulvectomy
remove labia, clitoris, etc.
can be for cancer or precancer
causes of vulvar lesions
cancer
bartholin gland cyst (drainage, antibiotics)
lichen sclerosus (peri and post menopausal, tx with antihistamines)
Cycle of abuse
- Tension building phase
- Acute battering incident (violence)
- Tranquil phase (honeymoon phase)
Characteristics of tranquil phase
If women is abused, women generally are not interested in seeking help but the batterer is more open to get help if offered
When are abused party most likely to seek help
Acute battering violence phase
Victim/survivor characteristics
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
Abuser characteristics
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
Elder abuse
- Over age of 65
- More women than men
- Domestic abuse, institutional abuse, self neglect
Other forms of abuse
Stalking Cyberstalking Sexual harassment Assault Date rape Homophobia
Rape trauma syndrome acute phase
Shock, disbelief
Embarrassment
Wants revenge
Suppress emotions but may also cry, sleep disturbances
Rape trauma syndrome: outward adjustment phase
Look composed outwardly
Might refuse to discuss
Might deny need for counseling
Might seek out security measures (i.e. self defense)
Rape trauma syndrome: Reorganization
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
Rape trauma syndrome: integration and recovery
Safe
Know to blame assailant
Advocacy stage
Might relapse (not linear)
Strategies to decrease violence
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
Nursing plan: violence
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
Inequality
Unequal access to opportunities
Equality
Evenly distributed tools and assistance
Equity
Custom tools that identify and address inequality
Justice
Fixing the system to offer equal access to both tools and opportunities
what % of women are carriers of GBS
10-40%
what can GBS lead to
endometritis, amniotis, UTI
how do you get GBS
during birth process or through ascending genital tract infection
How is CMV transmitted
birth process or placenta or breastmilk and saliva
What does UTIs increase the risk for as it relates to birth?
increased risk for premature birth, IUGR
Is breastfeeding contraindicated with a herpes lesion
breastfeeding = CI w/ breast lesion
When is a C section not indicated for HIV infected mom
C section not indicated for RNA < 1000 copies
Characteristics of moms with LGA babies
-mothers of LGA babies tend to be heavier, taller, older and of greater parity
Concerns with post maturity syndrome
mortality rate is 2-3 x higher than for term infants
decreased placental function impairs oxygenation and nutrition transport
placenta ages and calcifies
Hyperbili: erythroblastosis fetalis
Increase in immature RBCS
Pathologic
Hyperbili: hydros fetalis
Pathological
Destruction of RBCS
Severe anemia - could lead to death
