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OB/Community Health > Finals: New Content > Flashcards

Finals: New Content Flashcards

1
Q

What is pre-term birth ?

A

< 37 wks

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2
Q

What is post-term birth ?

A

> 42 wks

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3
Q

What are some S&S of respiratory distress in a preterm newborn ?

A
  • tachypnea
  • retractions
  • grunting
  • nasal flaring
  • crackles
  • cyanosis
  • apnea
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4
Q

Why are preterm newborns at risk for respiratory complications ?

A

lungs mature @ 36 wks
- have surfactant deficiency & immature lung development (primary origin)

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5
Q

What are some S&S of hypoglycemia in newborns ?

A
  • jitteriness
  • irritability
  • lethargy
  • grunting
  • sweating
  • apnea
  • seizures
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6
Q

What are the TORCH labs ?

A

common infects tested for when suspected
- Toxoplasmosis
- Other: HIV, syphilis, Zika, HBV
- Rubella
- Cytomegalovirus
- Herpes Simplex (HSV)

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7
Q

What is early onset sepsis ?

A
  • within 72 hrs of birth
  • progresses quickly
  • acquired from perinatal period from mom’s GI/GU
  • GBS, E.Coli, HSV, chlamydia
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8
Q

What is late onset sepsis ?

A
  • 7-28 days of birth
  • HAI or community acquired
  • staph, GBS, E.Coli, candida, MRSA, VRE
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9
Q

What are some characteristics of preterm infants ?

A
  • 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
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10
Q

What are late preterm infants more at risk for ?

A
  • altered thermoregulation
  • hypoglycemia
  • respiratory distress
  • hyperbilirubinemia
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11
Q

What is a late preterm infant ?

A

34 to 36 6/7 weeks

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12
Q

What are some characteristics of post term infants ?

A

progressive placental dysfunction
- loss of subq tissue
- skin cracked and peeling
- absence of lanugo & vernix
- long fingernails
- meconium stained

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13
Q

What is cold stress ?

A

lack of brown fat and small muscle mass which leads to lack of heat production
- large surface area/body mass leads to heat loss

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14
Q

What are some examples of neutral thermal environment ?

A
  • incubator
  • radiant heat warmer
  • open crib with clothing/blankets
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15
Q

How do we prevent hypoglycemia ?

A
  • 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
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16
Q

What is physiologic jaundice ?

A

mainly caused by immature liver
- occurs on day 2-5 of life
- decreases to adult levels by 10-14 days

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17
Q

What is pathologic jaundice ?

A

caused by a hemolytic disease, birth injury or instrument delivery
- severe that presents in the first 24 hrs

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18
Q

How does early and frequent breastfeeding help jaundice ?

A
  • colostrum promotes stooling for bilirubin excretion
  • adequate hydration also promotes elimination
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19
Q

What are some peripheral nervous birth injuries ?

A
  • Erb’s palsy
  • facial nerve paralysis
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20
Q

What are some S&S of fetal alcohol syndrome ?

A
  • abnormal facial features
  • growth restriction
  • neurodevelopmental deficits
  • ADHD
  • diminished fine-motor skills
  • poor speech
  • lack inhibition and judgement skills
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21
Q

What is a assessment tool for neonatal abstinence syndrome ?

A

Finnegan scoring

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22
Q

What are some important questions to ask when a women presents with bleeding ?

A
  • 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
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23
Q

What is a miscarriage ?

A

a pregnancy that ends due to natural causes before 20 wks

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24
Q

What is a threatened miscarriage and S&S ?

A

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

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25
Q

What is an inevitable miscarriage and S&S ?

A

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

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26
Q

What is a incomplete miscarriage and S&S ?

A

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

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27
Q

What is a complete miscarriage and S&S ?

A

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

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28
Q

Where is an ectopic pregnancy more likely to happen ?

A

fallopian tubes
- leading cause of infertility

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29
Q

What are the S&S of an ectopic pregnancy ?

A
  • 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
  • bleeding
    • mild, dark red or brown vaginal bleeding
    • concealed intrabdominal bleeding
      (cullen sign)
  • shock
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30
Q

Why may we give methotrexate to a pt who had a ectopic pregnancy ?

A

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

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31
Q

What is a hydatiform mole/molar pregnancy ?

A

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

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32
Q

What is the follow-up for a molar pregnancy ?

A

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

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33
Q

What are the S&S of a molar pregnancy ?

A
  • US: larger then normal uterus, grape-like clusters in uterus
  • hyperthyroidism
  • pulmonary embolism
  • HTN
  • anemia
  • increased N/V
  • vaginal bleeding
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34
Q

What are some risk factors for a placenta previa ?

A
  • prior C/S
  • prior previa
  • endometrial scarring
  • maternal age
  • smoking
  • multiparity
  • high altitude
  • multiple gestation
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35
Q

What are some S&S of a placenta previa ?

A
  • 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
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36
Q

How early can a placenta previa be diagnosed ?

A

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)

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37
Q

What is some expected management of a placenta previa ?

A
  • 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
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37
Q

What are the causes of placental abruption ?

A
  • maternal hypertension
  • cocaine use
  • blunt trauma to abdomen
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38
Q

What are the S&S of placental abruption ?

A

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

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39
Q

What are some complications of placental abruption ?

A
  • hemorrhage
  • hypovolemic shock
  • thrombocytopenia
  • DIC
  • infection
  • renal failure
  • pituitary necrosis
  • Rh isoimmunization
  • Fetus: intrauterine growth restriction, hypoxemia, stillbirth
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40
Q

What is Disseminated Intravascular Coagulation (DIC) ?

A

widespread bleeding caused by consumption of large amounts of clotting factors
- SECONDARY DIAGNOSIS
- need to treat the underlying cause to stop

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41
Q

What are the S&S of DIC and Tx ?

A
  • 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
42
Q

What is cervical insufficiency ?

A

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

43
Q

What is the tx for cervical insufficiency ?

A

cerclage placement: suture placed around the cervix to “close” the internal os
- prophylactic or rescue
- placed @ 11-15 wks and removed before 37 wks

44
Q

What is considered preterm ?

A

20 - 36 6/7 wks

45
Q

What is considered late preterm ?

A

34 - 36 6/7 wks

46
Q

What are some S&S of preterm labor ?

A
  • often painless contractions (>6/hr)
  • low, dull back pain
  • change in color/amount of vaginal discharge
  • pelvic pressure
  • abd cramps
  • increased urinary frequency
  • ROM
47
Q

How is preterm labor diagnosed ?

A
  • Fetal Fibronectin
  • Cervical length
48
Q

What is Fetal Fibronectin ?

A

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)

49
Q

What is a cervical length ?

A

measure the length of the cervix tissue via US
- normal: 3-5 cm
- short: 2.5 or less

50
Q

What interventions are available to prevent preterm labor ?

A
  • preconception counseling
  • progesterone supplementation
51
Q

How does progesterone supplementation help prevent preterm labor ?

A

found to decrease PTB in women in hx of it
- daily vaginal suppository or weekly IM
- @ 16-36 wks

52
Q

What is the purpose of Betamethasone with preterm labor ?

A

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

53
Q

What is the purpose of Magnesium Sulfate for preterm labor ?

A

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

54
Q

What are some side effects of magnesium sulfate ?

A
  • hot flashes, sweating
  • N/V, dry mouth
  • blurred vision, HA
  • muscle weakness, hypocalcemia
  • SOB, lethargy
  • fall risk measures and need 2 RN verification
55
Q

What is the antidote for Magnesium sulfate ?

A

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

56
Q

What is the purpose of Procardia for preterm labor ?

A

relaxes smooth muscle like the uterus by blocking calcium
- given PO
- hold if BP is low

57
Q

What are some SE of procardia ?

A
  • hypotension (first few days since body is adjusting to new BP)
  • dizziness, HA
  • facial flushing and nausea
58
Q

What is the purpose of Terbutaline for preterm labor ?

A

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)

59
Q

What are the S&S and adverse effects of Terbutaline ?

A

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

60
Q

What is the focus of treatment for hyperemesis gravidarum ?

A

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

61
Q

What is preeclampsia ?

A

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

62
Q

What is the diagnostic criteria for preeclampsia ?

A
  • 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)
63
Q

What is eclampsia ?

A

seizure activity
- persistent HA, blurry vision, severe abdominal pain
- stay @ bedside
- EFM: bradycardia, late decels, and decreased variability

64
Q

What is the tx options for a pregnant pt with HTN ?

A

Antihypertensive medications
- labetalol
- hydralazine
- nifedipine
SE:
- HA, flushing, hypotension
- monitor VS closely
- eval minimum of 20 mins before giving 2nd dose

65
Q

What is HELLP syndrome ?

A

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

66
Q

What are some risk factors for dysfunctional labor ?

A
  • 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
67
Q

What is malposition ?

A

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

68
Q

What are some measures to relieve back pain/labor ?

A
  • counterpressure with fist or heel of hand to sacral area
  • heat or cold application
  • all fours position, squatting, pelvic rock, or lateral position
69
Q

What is malpresentation ?

A

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

70
Q

What are some risk factors for malpresentation ?

A
  • multiples
  • preterm labor & birth
  • fetal & maternal anomalies
  • oligo/polyhydramnios
  • trisomy (13,18,21)
  • neuromuscular disorders
71
Q

What is external cephalic version ?

A

attempt to manually turn baby into cephalic/vertex position
- if unsuccessful, then C/S

72
Q

What are some RN considerations for a external cephalic version (ECV) ?

A
  • empty bladder
  • fetal monitor before and after
  • pain meds, RhoGAM if needed
  • US at bedside
  • tocolytic agent: terbutaline
  • VS
73
Q

What are some indications for a operative/assisted vaginal birth ?

A

forceps or vacuum (contraindicated <34 wks)
- prolonged 2nd stage
- fetal distress
- maternal exhaustion
- abnormal presentation (assist with head delivery in breech presentation)

74
Q

What are some RN consideration for a operative/assisted vaginal birth ?

A
  • 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
75
Q

What is the difference between Caput and cephalohematoma ?

A

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

76
Q

What are some indications for a C/S ?

A
  • 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
77
Q

What are some complications of a C/S ?

A
  • 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)
78
Q

Who may be a candidate for VBAC ?

A
  • one or two previous low transverse (side to side) uterine incisions
  • adequate pelvis
  • no other uterine scares or rupture
  • physician immediately available
79
Q

What is TOL or TOLAC ?

A

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

80
Q

What are some maternal risks of post-term pregnancies ?

A
  • dysfunctional labor
  • perineal injury
  • hemorrhage
  • infection
  • pitocin/forceps/vacuum and c/s
    Will do: NSTs/BPPS x2 a week
81
Q

What are some fetal risks of post-term pregnancy ?

A

PLACENTAL AGING
- macrosomia
- shoulder dystocia
- birth injuries
- oligohydramnios
- meconium stained fluid
- stillbirth

82
Q

What is shoulder dystocia ?

A

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

83
Q

What are some RN considerations of a shoulder dystocia ?

A
  • 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
84
Q

What is a prolapsed umbilical cord ?

A

when cord lies below presenting part of fetus
Contributing factors include:
- long cord (longer then 100 cm)
- malpresentation (breech)
- transverse lie
- unengaged presenting part

85
Q

What are some S&S of a prolapsed umbilical cord ?

A
  • abnormal FHR
  • variable or prolonged decels
  • feeling cord after ROM
  • cord is seen or felt in vagina
86
Q

What are some RN considerations for a prolapsed umbilical cord ?

A
  • 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
  • provide O2, start IV fluids
  • reassure pt and family
  • prepare for imminent vaginal delivery (only if 10 cm) or STAT c/s
87
Q

What is the most common cause of uterine rupture ?

A

scarred uterus from previous c/s

88
Q

What are some risk factors for uterine rupture ?

A
  • fetal macrosomia
  • infection
  • short pregnancy interval
  • overstimulation during induction (tachysystole)
  • multiple gestation
89
Q

What are some S&S of uterine rupture ?

A
  • 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
90
Q

What are the RN considerations for a uterine rupture ?

A
  • 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
91
Q

What is anaphylactoid syndrome of pregnancy ?

A

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

92
Q

What are some RN considerations for anaphylactoid syndrome of pregnancy ?

A
  • 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
93
Q

What are the components of the epidemiology triangle ?

A
  • agent: cause of disease (exposure)
  • host: carrier of disease (human)
  • environment: surroundings of the host
94
Q

What is surveillance ?

A

the ongoing systematic collection, analysis, and interpretation of health data

95
Q

What is a endemic ?

A

baseline, expected presence of disease

96
Q

What is a epidemic ?

A

presence of disease above the expected level

97
Q

What is a pandemic ?

A

epidemic that has spread to a larger scale

98
Q

What is I PREPARE stand for ?

A
  • I: investigate potential exposures
  • P: present work
  • R: residence
  • E: environmental concerns
  • P: past work
  • A: activities
  • R: referrals and resources
  • E: educate
99
Q

How is I PREPARE used to conduct environmental assessments ?

A

to evaluate the potential effects of environmental factors on public health

100
Q

What happens in the prevention/mitigation stage of a disaster ?

A
  • assess for potential threats to stop a disaster from happening or to mitigate the effects
  • repair or remove any identifies threats to vulnerabilities
101
Q

What happens in the preparedness stage of a disaster ?

A
  • identify emergency shelter locations
  • identify community evac routes
  • stock pile food, water, meds and first-aid equipment
  • perform regular drills
102
Q

What happens in the response stage of a disaster ?

A
  • 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
103
Q

What happens in the recovery stage of a disaster ?

A

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

OB/Community Health (12 decks)

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