Finals: New Content Flashcards
What is pre-term birth ?
< 37 wks
What is post-term birth ?
> 42 wks
What are some S&S of respiratory distress in a preterm newborn ?
- tachypnea
- retractions
- grunting
- nasal flaring
- crackles
- cyanosis
- apnea
Why are preterm newborns at risk for respiratory complications ?
lungs mature @ 36 wks
- have surfactant deficiency & immature lung development (primary origin)
What are some S&S of hypoglycemia in newborns ?
- jitteriness
- irritability
- lethargy
- grunting
- sweating
- apnea
- seizures
What are the TORCH labs ?
common infects tested for when suspected
- Toxoplasmosis
- Other: HIV, syphilis, Zika, HBV
- Rubella
- Cytomegalovirus
- Herpes Simplex (HSV)
What is early onset sepsis ?
- within 72 hrs of birth
- progresses quickly
- acquired from perinatal period from mom’s GI/GU
- GBS, E.Coli, HSV, chlamydia
What is late onset sepsis ?
- 7-28 days of birth
- HAI or community acquired
- staph, GBS, E.Coli, candida, MRSA, VRE
What are some characteristics of preterm infants ?
- minimal subq fat
- large head in relation to body
- translucent skin (smooth, pink, shiny, blood vessels visible)
- lanugo
- minimal creases on palms and soles
- hypotonic
- underdeveloped reflexes
- eyes may be fused
- ears soft and pliable
What are late preterm infants more at risk for ?
- altered thermoregulation
- hypoglycemia
- respiratory distress
- hyperbilirubinemia
What is a late preterm infant ?
34 to 36 6/7 weeks
What are some characteristics of post term infants ?
progressive placental dysfunction
- loss of subq tissue
- skin cracked and peeling
- absence of lanugo & vernix
- long fingernails
- meconium stained
What is cold stress ?
lack of brown fat and small muscle mass which leads to lack of heat production
- large surface area/body mass leads to heat loss
What are some examples of neutral thermal environment ?
- incubator
- radiant heat warmer
- open crib with clothing/blankets
How do we prevent hypoglycemia ?
- initiate early feedings
- frequent feedings (2 1/2- 3 hrs)
- monitor BS with feeds
- supplement with formula or dextrose per protocol
- assess for hypoglycemia or respiratory distress
What is physiologic jaundice ?
mainly caused by immature liver
- occurs on day 2-5 of life
- decreases to adult levels by 10-14 days
What is pathologic jaundice ?
caused by a hemolytic disease, birth injury or instrument delivery
- severe that presents in the first 24 hrs
How does early and frequent breastfeeding help jaundice ?
- colostrum promotes stooling for bilirubin excretion
- adequate hydration also promotes elimination
What are some peripheral nervous birth injuries ?
- Erb’s palsy
- facial nerve paralysis
What are some S&S of fetal alcohol syndrome ?
- abnormal facial features
- growth restriction
- neurodevelopmental deficits
- ADHD
- diminished fine-motor skills
- poor speech
- lack inhibition and judgement skills
What is a assessment tool for neonatal abstinence syndrome ?
Finnegan scoring
What are some important questions to ask when a women presents with bleeding ?
- gestational age/due date
- events leading up to the bleeding
- any fetal movement or contractions
- obstetrical hx
- ABOrh
- any previous bleeding
- last US
- pain levels
- give IV pain meds in case need to be NPO
What is a miscarriage ?
a pregnancy that ends due to natural causes before 20 wks
What is a threatened miscarriage and S&S ?
will either resolve or will go to inevitable
- slight/scant bleeding
- mild cramping
- cervix not dilated
- fetus is living
Tx:
- will do US and monitor HCG for rise or fall
- no evidence for bedrest benefits
What is an inevitable miscarriage and S&S ?
fetus won’t live and nothing can be done to stop this
- moderate bleeding
- mild to severe cramping
- cervix is dilated
Tx:
- Med management: Cytotec to contract uterus to expel contents
- Dilation & Curettage (D&C): dilate and suction contents out
What is a incomplete miscarriage and S&S ?
fetus is delivered but placenta isn’t
- heavy bleeding
- cervix is dilated
- expulsion of fetus and retention of placenta
Tx:
- hemodynamic stabilization: replace blood volume and give meds to contract uterus
- D&C: to get rid of placenta
What is a complete miscarriage and S&S ?
all fetal tissue is passed
- cervix is dilated and all fetal tissues passes
- followed by mild cramping and bleeding
Tx:
- pain management
- supportive/emotional care
Where is an ectopic pregnancy more likely to happen ?
fallopian tubes
- leading cause of infertility
What are the S&S of an ectopic pregnancy ?
- missed period
- pain
- ranges from dull to colicky as tube
stretches - unilateral, deep lower abdomen
- increases with rupture of tube (sharp,
stabbing) - referred shoulder pain from blood
accumulation in peritoneal cavity
- ranges from dull to colicky as tube
- bleeding
- mild, dark red or brown vaginal bleeding
- concealed intrabdominal bleeding
(cullen sign)
- shock
Why may we give methotrexate to a pt who had a ectopic pregnancy ?
kills cells that are developing (in this case the embryo)
- 1 IM injection
- will be more sensitive to the sun so need SPF
- no folic acid because it decreases effectivity
- don’t eat lots of gassy foods
What is a hydatiform mole/molar pregnancy ?
when what should be the placenta tissue turns into a trophoblastic tissue which can turn malignant (cancerous) if not removed
- complete: no maternal material
- incomplete: 1 set of maternal material
What is the follow-up for a molar pregnancy ?
follow HCG every month for 6 months and then every 2 months for 1 year
- can lead to cancer because the tissue can migrate to other places
- can’t get pregnancy while we monitor HCG
- increase in HCG can indicate developing malignancy
What are the S&S of a molar pregnancy ?
- US: larger then normal uterus, grape-like clusters in uterus
- hyperthyroidism
- pulmonary embolism
- HTN
- anemia
- increased N/V
- vaginal bleeding
What are some risk factors for a placenta previa ?
- prior C/S
- prior previa
- endometrial scarring
- maternal age
- smoking
- multiparity
- high altitude
- multiple gestation
What are some S&S of a placenta previa ?
- painless, bright red vaginal bleeding
- soft. non-tender uterus
- VS may be normal but can change quickly so monitor for signs of shock
- suspect when pt has bleeding after 24 wks
How early can a placenta previa be diagnosed ?
as early as 18 wks
- if diagnosed at 18 wks via US then will need another US at 28 wks:
- if resolved then pt can deliver vaginally
- if still present at 28 wks then we will
continue to monitor US and plan for C/S
- transabdominal ultrasound (will never put anything into the vagina to avoid damage)
What is some expected management of a placenta previa ?
- if <36 wks with minimal bleeding and not in labor we will give the fetus time to mature in utero
- pelvic rest
- bedrest with bathroom privileges or commode
- US q 2 wks, BPP once or twice weekly with NST
- give betamethasone to promote fetal lung maturity
- assess bleeding, VS, FHR, Ctx, Hgb
- maintain saline lock and current type & screen
- document fetal lung maturity @ 37 wks (via amniocentesis) and if mature consider C/S
What are the causes of placental abruption ?
- maternal hypertension
- cocaine use
- blunt trauma to abdomen
What are the S&S of placental abruption ?
symptoms vary with degree of separation
- dark red vaginal bleeding
- abdominal pain/tenderness
- contractions (uterine tetany): board-like abdomen
- with partial/apparent separation you will see classic signs
- with partial/concealed you may not see signs and fetus may be able to compensate
What are some complications of placental abruption ?
- hemorrhage
- hypovolemic shock
- thrombocytopenia
- DIC
- infection
- renal failure
- pituitary necrosis
- Rh isoimmunization
- Fetus: intrauterine growth restriction, hypoxemia, stillbirth
What is Disseminated Intravascular Coagulation (DIC) ?
widespread bleeding caused by consumption of large amounts of clotting factors
- SECONDARY DIAGNOSIS
- need to treat the underlying cause to stop
What are the S&S of DIC and Tx ?
- unusual heavy bleeding anywhere there was an injection/injury
- labs show decreased platelets, fibrinogen, and prothrombin
Tx: - volume replacement, blood products, O2
- watch for renal failure
- urinary output should be more then 30 ml/hr
What is cervical insufficiency ?
passive and painless dilation of the cervix leading to preterm birth in the second trimester without any other cause
- diagnosed via US showing cervix less then 2.5 cm of cervical funneling
What is the tx for cervical insufficiency ?
cerclage placement: suture placed around the cervix to “close” the internal os
- prophylactic or rescue
- placed @ 11-15 wks and removed before 37 wks
What is considered preterm ?
20 - 36 6/7 wks
What is considered late preterm ?
34 - 36 6/7 wks
What are some S&S of preterm labor ?
- often painless contractions (>6/hr)
- low, dull back pain
- change in color/amount of vaginal discharge
- pelvic pressure
- abd cramps
- increased urinary frequency
- ROM
How is preterm labor diagnosed ?
- Fetal Fibronectin
- Cervical length
What is Fetal Fibronectin ?
tests the vaginal/cervical secretions for a glycoprotein produced by the fetal cells that binds the fetal sac to the uterine lining
- normal in vaginal fluid <22 wks and >36 wks
- abnormal: 22-36 wks
- has a reliable (-) predictive results while not a reliable (+) result (good sensitivity)
- swab the cervix
- presence in late 2nd and early 3rd trimester can be related to placental inflammation (while can lead to PTL)
What is a cervical length ?
measure the length of the cervix tissue via US
- normal: 3-5 cm
- short: 2.5 or less
What interventions are available to prevent preterm labor ?
- preconception counseling
- progesterone supplementation
How does progesterone supplementation help prevent preterm labor ?
found to decrease PTB in women in hx of it
- daily vaginal suppository or weekly IM
- @ 16-36 wks
What is the purpose of Betamethasone with preterm labor ?
corticosteroid that promotes fetal lung maturity
- for any mother @ risk for PTB from 24-36 wks
- side effects: increased WBC, hyperglycemia
- need 2 days for effectiveness
What is the purpose of Magnesium Sulfate for preterm labor ?
CNS depressant that relaxes smooth muscles like the uterus
- for fetal neuroprotection (in cases of PPROM)
- to prolong pregnancy to be able to get mom to higher level of care or to give betamethasone time to be effective
What are some side effects of magnesium sulfate ?
- hot flashes, sweating
- N/V, dry mouth
- blurred vision, HA
- muscle weakness, hypocalcemia
- SOB, lethargy
- fall risk measures and need 2 RN verification
What is the antidote for Magnesium sulfate ?
calcium gluconate (toxicity for Mag is >8 mg/dL)
- Adverse Effects:
- RR <12
- UO < 30mL/hr
- altered LOC
- pulmonary edema & chest pain
- loss of deep tendon reflexes
- decrease FHR variability/breathing
What is the purpose of Procardia for preterm labor ?
relaxes smooth muscle like the uterus by blocking calcium
- given PO
- hold if BP is low
What are some SE of procardia ?
- hypotension (first few days since body is adjusting to new BP)
- dizziness, HA
- facial flushing and nausea
What is the purpose of Terbutaline for preterm labor ?
relaxes smooth muscles, inhibits uterine activity and causes bronchodilation
- short term
- used more for mild contractions, if severe we will skip this and give Mag
- check HR before admin (hold for HR >180)
What are the S&S and adverse effects of Terbutaline ?
S&S:
- tachycardia, hypotension
- chest discomfort, palpations
- tremors, dizziness, HA
- N/V
- hypokalemia and hyperglycemia
AE:
- HR >130
- BP <90/60
- pulmonary edema
- chest pain, MI
- DEATH
What is the focus of treatment for hyperemesis gravidarum ?
restoring fluid volume
- typically starts @ 10 wks and resolves by 20 wks
Tx:
- daily weights, I&Os, VS
- fluid and electrolyte balance
- clear liquids & bland diet
What is preeclampsia ?
multisystemic condition caused by inflammation and activation of endothelium
- SBP greater than or equal to 140 and/or DBP greater than or equal to 90
What is the diagnostic criteria for preeclampsia ?
- elevated BP x2 taken at least 4 hrs apart
- proteinuria
- thrombocytopenia (<100,000)
- renal insufficiency
- liver function tests twice the normal value (AST,ALT,LDH)
What is eclampsia ?
seizure activity
- persistent HA, blurry vision, severe abdominal pain
- stay @ bedside
- EFM: bradycardia, late decels, and decreased variability
What is the tx options for a pregnant pt with HTN ?
Antihypertensive medications
- labetalol
- hydralazine
- nifedipine
SE:
- HA, flushing, hypotension
- monitor VS closely
- eval minimum of 20 mins before giving 2nd dose
What is HELLP syndrome ?
variant or pre-eclampsia that mainly affects the blood and liver and it progresses rapidly
- may or may not have s/s of eclampsia but instead “flu-like” symptoms
- Hemolysis
- Elevated Liver enzymes
- Low Platelets
What are some risk factors for dysfunctional labor ?
- overweight
- short stature
- advanced maternal age
- infertility
- external cephalic version
- masculine characteristics (android pelvis)
- uterine abnormalities
- fetal malpresentation
- cephalopelvic disproportion
- tachysystole
- fatigue, dehydration, pain meds, epidural
What is malposition ?
when the back of the fetal head to rubbing against the tailbone
- persistent occiput posterior (OP)
- prolonged 2nd stage of labor
- causes severe back pain
What are some measures to relieve back pain/labor ?
- counterpressure with fist or heel of hand to sacral area
- heat or cold application
- all fours position, squatting, pelvic rock, or lateral position
What is malpresentation ?
anything other then cephalic/vertex presentation
- breech is most common
- risk of prolapsed cord & trapping of fetal head which can lead to hypoxia and death
- Diagnosis: Leopold’s maneuver, vaginal exam, confirmed by US
What are some risk factors for malpresentation ?
- multiples
- preterm labor & birth
- fetal & maternal anomalies
- oligo/polyhydramnios
- trisomy (13,18,21)
- neuromuscular disorders
What is external cephalic version ?
attempt to manually turn baby into cephalic/vertex position
- if unsuccessful, then C/S
What are some RN considerations for a external cephalic version (ECV) ?
- empty bladder
- fetal monitor before and after
- pain meds, RhoGAM if needed
- US at bedside
- tocolytic agent: terbutaline
- VS
What are some indications for a operative/assisted vaginal birth ?
forceps or vacuum (contraindicated <34 wks)
- prolonged 2nd stage
- fetal distress
- maternal exhaustion
- abnormal presentation (assist with head delivery in breech presentation)
What are some RN consideration for a operative/assisted vaginal birth ?
- bladder empty
- cervix completely dilated
- membranes ruptured
- fetal head engaged in pelvis (head has to be low in pelvis)
- vertex presentation
- maternal assessment (lacerations, hematomas)
- fetal assessment
- DOCUMENT
What is the difference between Caput and cephalohematoma ?
Caput:
- collection of fluid under the scalp and it crosses the suture lines
- usually resolves in 3-5 days
Cephalohematoma:
- collection of blood under the skin that does not cross the suture line
What are some indications for a C/S ?
- cephalopelvic disproportion (fetal head doesn’t fit through pelvis)
- malpresentations (breech)
- placental abnormalities (previa, abruption)
- dysfunctional labor pattern
- umbilical cord prolapse
- fetal distress
- congenital anomalies
- multiple gestation
- HTN disorders in mom
- active genital herpes (HSV)
- (+) HIV status in mom with high viral load (>1000)
- elective or repeat C/S
What are some complications of a C/S ?
- infection (wound, UTI)
- endometritis
- wound dehiscence
- aspiration
- DVT & pulmonary embolism
- atelectasis
- hemorrhage, blood transfusion
- injury to bowel or bladder
- complications of anesthesia
- fetal injuries & increased respiratory distress for newborn
- uterine rupture or abnormal placental implantation (previa, accreta)
Who may be a candidate for VBAC ?
- one or two previous low transverse (side to side) uterine incisions
- adequate pelvis
- no other uterine scares or rupture
- physician immediately available
What is TOL or TOLAC ?
trial of labor or trial of labor after cesarean
- observation of a woman and her fetus for a specified length of time to asses safety of vaginal birth
What are some maternal risks of post-term pregnancies ?
- dysfunctional labor
- perineal injury
- hemorrhage
- infection
- pitocin/forceps/vacuum and c/s
Will do: NSTs/BPPS x2 a week
What are some fetal risks of post-term pregnancy ?
PLACENTAL AGING
- macrosomia
- shoulder dystocia
- birth injuries
- oligohydramnios
- meconium stained fluid
- stillbirth
What is shoulder dystocia ?
the head is born but anterior shoulder cannot pass under pubic arch
- Turtle Sign: head emerges and immediately retracts against perineum; warning that birth of shoulders may be difficult
- newborn is more likely to get birth injury like to the brachial plexus
What are some RN considerations of a shoulder dystocia ?
- call for help
- McRoberts Maneuver: women’s legs flexed apart with knees on her abdomen to straighten symphysis and rotate toward mom’s head
- Suprapubic Pressure: applying pressure above the symphysis pubis to free anterior shoulder
What is a prolapsed umbilical cord ?
when cord lies below presenting part of fetus
Contributing factors include:
- long cord (longer then 100 cm)
- malpresentation (breech)
- transverse lie
- unengaged presenting part
What are some S&S of a prolapsed umbilical cord ?
- abnormal FHR
- variable or prolonged decels
- feeling cord after ROM
- cord is seen or felt in vagina
What are some RN considerations for a prolapsed umbilical cord ?
- call for help
- relieve pressure on cord by:
- place sterile gloved hand in vagina and
pushing up on presenting part - place pt in modified sims or knee-chest
position
- place sterile gloved hand in vagina and
- provide O2, start IV fluids
- reassure pt and family
- prepare for imminent vaginal delivery (only if 10 cm) or STAT c/s
What is the most common cause of uterine rupture ?
scarred uterus from previous c/s
What are some risk factors for uterine rupture ?
- fetal macrosomia
- infection
- short pregnancy interval
- overstimulation during induction (tachysystole)
- multiple gestation
What are some S&S of uterine rupture ?
- abnormal FHR tracing
- loss of fetal station
- abdominal pain (constant, severe)
- uterine tenderness
- change in uterine shape
- pt may have felt a “pop”
- may be able to palpate fetal parts through abdomen
- cessation of contractions
- shock
What are the RN considerations for a uterine rupture ?
- start IV fluids, O2, prepare for blood transfusions, and immediate c/s and repair of uterus
- may need hysterectomy
- frequent nursing assessments
- FHR & contraction pattern
- follow protocol for induction & meds to avoid tachysystole
- asses for hemorrhage after deliveryq
What is anaphylactoid syndrome of pregnancy ?
anaphylactic-like reaction to amniotic fluid when it enters the maternal circulation
- acute onset of hypotension, hypoxia, cardiovascular collapse and coagulopathy
- shock -> cardiac arrest -> CPR -> DIC
- neonatal outcome is poor
What are some RN considerations for anaphylactoid syndrome of pregnancy ?
- O2, IVF, left lateral position
- displace uterus during CPR
- prepare for imminent c/s once pt is stable
- intubation to support respiratory status
- admins blood products- MBTP
- provide emotional support to pt and family
What are the components of the epidemiology triangle ?
- agent: cause of disease (exposure)
- host: carrier of disease (human)
- environment: surroundings of the host
What is surveillance ?
the ongoing systematic collection, analysis, and interpretation of health data
What is a endemic ?
baseline, expected presence of disease
What is a epidemic ?
presence of disease above the expected level
What is a pandemic ?
epidemic that has spread to a larger scale
What is I PREPARE stand for ?
- I: investigate potential exposures
- P: present work
- R: residence
- E: environmental concerns
- P: past work
- A: activities
- R: referrals and resources
- E: educate
How is I PREPARE used to conduct environmental assessments ?
to evaluate the potential effects of environmental factors on public health
What happens in the prevention/mitigation stage of a disaster ?
- assess for potential threats to stop a disaster from happening or to mitigate the effects
- repair or remove any identifies threats to vulnerabilities
What happens in the preparedness stage of a disaster ?
- identify emergency shelter locations
- identify community evac routes
- stock pile food, water, meds and first-aid equipment
- perform regular drills
What happens in the response stage of a disaster ?
- actions taken during and immediately after a disaster
- activate the disaster plan
- provide triage and ongoing care to victims
- establish surveillance of outbreak or bioterrorism if suspected
What happens in the recovery stage of a disaster ?
begins when threat no longer exists
- provide RN and medical care to victims
- assist with reunification of families and ongoing assessments
- aid in eval to response
- participate in revising plan to improve it
