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Maternity nursing 231 > High risk antepartum > Flashcards

High risk antepartum Flashcards

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1
Q

Trichomoniasis

Cause

A

Anaerobic protozoan T. vaginalis
thrives in alkaline environment
affects skenes glands

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2
Q

Trich male S&S

A

asymptomatic
dysuria
burning on urination

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3
Q

Trich female S&S

A

asymptomatic
fishy smell
yellow-green, brownish grey discharge
Strawberry cervix

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4
Q

Dx of trich

A 
wet mount (N.s and K)
whiff test KOH added: fishy smell
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5
Q

Tx of trich

A

metronidazole (Flagyl)

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6
Q

Trich teaching

A

Avoid intercourse till infection is clear
Continue tx thru menses
treat partner
if pregn, cut in half and give BID for 7 days
Can be given during the first trimester
If untreated: ROM–premature delivery
Lactating: take the dose and avoid breastfeeding for 24 hours. Pump and discard and resume after 24 hrs
No alcohol—Antabuse like effect
Take med with food (GI distress)
Metallic taste in mouth (chew gum)
Changes urine to dark brown-red
puts woman at risk for yeast infection (treat with Diflucan or monistat/terasol cream)

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7
Q

Chlamydia cause

A

c.trachoatis

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8
Q

S&S of chlamydia in women

A 
vaginal discharge
spotting after sex
lower abdominal pain
dysuria
coexists with gonorrhea
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9
Q

S&S of gonorrhea in men

A

discharge from penis
burning in urination
swollen or painful testicles

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10
Q

Dx of chlamydia

A

culture
urine test
all women <25 receive culture with pap smear.

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11
Q

Tx of Chlamydia

A

Doxycycline if not preg.

Zithromax if preg.

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12
Q

Teaching of Doxycycline

A

not given to preg. women.

It can causes fetal tooth staining

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13
Q

Baby born to woman with chlamydial infection

A 
chlamydia pneumonia
opthalmia neonatorum (erythromycin)
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14
Q

Untreated Chlamydia or Gonorrhea during pregnancy can lead to

A

PROM

Chorioamnionitis

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15
Q

Untreated chlamydia in non pregnant

A

Scarring of fallopian tubes: infertility and ectopic pregnancy
PID

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16
Q

Gonorrhea

Clap cause

A

gram - aerobic bacterium: Neisseria Gonorrhea
Bathrolins cyst
In cervix, skenes glands, lower Urinary tract, pharynx and rectum

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17
Q

Gonorrhea S&S men

A

asymptomatic

dysuria and penile discharge

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18
Q

Gonorrhea S&S women

A 
Greenish yellow discharge
dysuria
pelvic pain
Painful intercourse
Irreg. vaginal bleeding
red, tender, swollen vulva
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19
Q

Dx of gonorreha

A

culture

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20
Q

Tx of gonorrhea

A

Rocephin

treat chlamydia as well with doxycycline (nonpreg) and zithromax (preg)

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21
Q

Syphilis cause

A

spirochete Treptonema pallidum

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22
Q

Syphilis untreated leads to

A

Multiple Organ disease

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23
Q

Syphilis acquired

A

utero, sexually, touching infected wound

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24
Q

Primary stage syphilis

A

Highly contagious

Chancre: red, swollen, pea sized ulcerations on penis, vagina cervix or mouth. Painless. Heals in 5-6 weeks

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25
Q

Secondary stage syphilis

A 
6 weeks to 5 months after chancre healed
Macular rash on hands and feet that doest itch. 
Resembles measles.
Hepatoslpenomegaly
Flulike S&S
Hair sparse: loss of hair in patches
lasts 2-6 weeks
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26
Q

Tertiary Stage syphilis

A

Involves multiple organs
1-50 years after first symptoms
General psychosis, paralysis and death

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27
Q

Dx of syphilis

A

VDRL blood test (1st prenatal visit and 36 weeks). If +: do RPR
once active inflammation, VDRL always has low titer
RPR: verifies if low titer is prior exposure or active disease

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28
Q

Tx of syphilis

A

Penicillin

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29
Q

If syphilis while pregnant

A

Spontaneous abortion
Stillborn
congenital syphilis (blindness, deafness and mental retardation)

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30
Q

HPV/ Condyloma Acuminata

types

A

6 &11: genital warts

16&18: cervical cancer

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31
Q

HPV transmission

A

sexual contact and contact with warts themselves. Anal and genital areas

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32
Q

S&S HPV

A

asymptomatic

warts anywhere in perineal area

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33
Q

Dx of HPV

A

visual inspection and detailed pt Hx

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34
Q

Tx of HPV

A 
most go away
Only relieving symptoms
Trichloric acid
prilotherapy
paladine
Aldara cream

NO NEED FOR C-SECTION

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35
Q

Complications of HPV if had it during pregnancy

A

Laryngeal Papillomas in baby (warts in throat)

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36
Q

Prevention of HPV

A 
Gardasil Vaccine:
3 doses: 1st age 9-12, 2nd one month after and 3rd 6 mod after 2nd. 
Parental consent neded
Contraindicated if yeast allergies
Defferred during pregnancy
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37
Q

Herpes Simplex Virus

A

Chronic, never goes away

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38
Q

Herpes type 1

A

Cold sores and blisters (face, lips, nose and chin) they come and go
Pruritic and itchy
Tx: Valtrex

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39
Q

Herpes type 2
Tx
teach
worst

A

Genital Herpes (can gave type 1 here too)
Valtrex for rest of their lives
extremely painful
pt may not drink and get dehydrated due to painful urination. Teach them to urinate while sitting in a tub of warm water or squirt warm water on genital area during urination.
1st episode is the worst (low F, painful vesicles, lymphadenopathy)

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40
Q

Dx of Herpes

A

Visualization of lesions
viral culture of fluid
blood for antibody titer

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41
Q

Tx of Herpes

A

No cure
Acyclovir (32-3 weeks too) or Valtrex to slow down shedding
comfort care, cleansing area is crucial to avoid inf.
IF herpes present at time of delivery: C-section

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42
Q

Placenta Previa predisposing factors

A

C-sections Hx
Multiparity
Increased maternal age
smoke and cocaine use

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43
Q

Complete placenta previa tx

A

need a c-section

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44
Q

Marginal Placenta previa/low lying

tx

A

within 3 cm of os

Vaginal birth is possible

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45
Q

Partial placenta previa tx

A

need a c-section

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46
Q

S&S of placenta previa

A

painless vaginal bleeding
Uterus is soft, relaxed, nontender
usually toward end of 2nd trimester and beginning of 3rd trimester.

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47
Q

Dx of Placenta previa

A

sonogram (14 weeks) may indicate low lying placenta but is normal and as it grows it is brought up. Come back for sonogram

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48
Q

Tx of placenta previa

A

Needs to know the possibility of C-section
Teach S&S of labor to woman because she needs to come right away
very conservative
VAGINAL EXAMS NOT DONE
go home and rest
put legs up, do pad counts, FHR monitor

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49
Q

HELLP Syndrome
what do the words stand for?
What is it?

A 
Hemolysis
Elevated
Liver enzymes
Low
Platelets
-Extension of severe preeclampsia
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50
Q

Etiology or HELLP

A

white
multipara
Preeclampsia
<36th week (90%)

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51
Q

S&S of HELLP

A 
misdiagnosed as gall bladder or flu
N/V
Flu like symptoms
Malaise
RUQ gastric pain (due to high liver enzymes and hemolysis)
HTN
RISK FOR IMPENDING SEIZURE
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52
Q

Labs for HELLP

A

CBC
platelet count
Liver enzyme studies

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53
Q

Tx for HELLP

A

Prompt delivery no matter what age
Fresh frozen plasma
Packed RBC

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54
Q

Maternal risks of HELLP

A

Increased intraocular pressure: detached retina and blindness, cerebral hemorrhage and, stroke out and die

55
Q

Fetal risks of HELLP

A

small baby SGA (vasospasm, vasoconstriction, poor perfusion

Hypermagnesemia (if given mg sulfate): decreased reflex, oliguria

56
Q

Preeclampsia

what is it?

A

High BP and protein in urine that develops after 20 weeks of pregnancy.

57
Q

Mild preeclampsia BP

A

<140/90
protein urine: 1 or +2
elevated liver enzymes
lived edema

58
Q

Tx of Mild preeclampsia

A 
manage at home if compliant:
frequent rest periods
no watching over children
No strict bed rest, she can get up and walk to the br, kitchen
Left side position
Weigh daily
Monitor protein in urine (if >2 call doc)
BP daily
Fetal kick counts
NST and BPP
High protein diet/ avoid salty food.
59
Q

Signs that mild preeclampsia is getting worse

A

visual disturbances
severe headache
GI pain, epigastric pain. liver enlargement

60
Q

Severe preeclampsia BP

A

BP 160/110 or higher

Protein: 2 or 4+

61
Q

S&S of severe preeclampsia

A

blurred vision r/t cerebral edema
decreased urinary output
facial and sacral edema

62
Q

Tx of severe preeclampsia

A 
Hospitalized
Low stimulus environment
Private room at end of hall
Lights out
Assess for CLONUS (jerking movement on foot)
bed rest
BP meds (antihypertensive: Apresoline : if diastolic > 110. increases CO and placental blood flow)
Mg. Sulfate
GET BABY OUT
63
Q

Epigastric pain with severe preeclampsia

A

sign that she is going not eclampsia!!

64
Q

Mg Sulfate
Normal levels
toxicity

A

4-8 mg
Given in severe preeclampsia to prevent seizures
CNS depr. anticonvulsant/ smott muscle relaxant/decreases vasoconstriction
Used to stop preterm labor
IV as a secondary line
TOx: Absence of DTR, skin flush, warm feelings, oliguria, N/V, reap. depression, drooling
Ca gluconate (antidote)
NI: BP/RR/DTR/Ur.Output/Pulseox/resuscitation equip.

65
Q

Risk factors for high BP while pregn

A 
primipara
existing DM
Multigestations
Young and old
Hx of preeclampsia
66
Q

Eclampsia can cause

A

Pt to go into labor and have precipitous birth

Poor placental perfusion and oxygenation

67
Q

Complications of eclampsia

A

Cerebral hemorrhage: blurry vision/spots in eyes/hyperactive reflexes
Decreased placental blood circulation: IUGR, Hypoxia

68
Q

Tx of eclampsia

A 
airway, oxygen, side position (aspiration), suction PRN, no restraint.
Is fluid urine or ROM
Nitrazine test
vaginal exam after seizure (to see if she is going into labor)
uterine contractions?
FHR
Auscultate lungs (aspiration)
Mg sulfate or Hydralazine
Board like abdmen??---Abruptio placentae
69
Q

HIV NI

A 
proper hand washing to avoid inf
32 weeks NST
sonograms 3rd trimester
Internal monitoring and episiotomies AVOIDED 
ZVD (AZT) during labor
NO breastfeeding
Birth control education
standard precautions
70
Q

Baby born to HIV mother

A

Bactrim for 6 weeks to prevent pneumocystits pneumonia

r/o inf: 4 polymerase chain reaction test over 4 months (negative tests: no infection)

71
Q

Yeast infection/monilia factors that increase it

A 
pregnancy
abxs
Oral contraceptives
douching
diabetes 
Diabetes
72
Q

monilia S&S

A

thick, curd like cottage cheese discharge
painful intercourse
dyrsuria
red and painful labia and vulva

73
Q

Dx of monilia

A

vaginal secretions wet mount

presence of hyphaed yeast buds

74
Q

Tx monilia

A

terazol cream
OTC monistat
Diflucan (not for preg. 24 hrs to work)

75
Q

Bacterial Vaginosis S&S

A

thin, grey discharge with fishy odor

76
Q

Dx of bacterial vaginosis

A

wet mount: epithelial cells with edges all around due to bacteria sticking to them
Add KOH to elecit + amine test: fishy odor

77
Q

Tx of B.V

A

Flagyl BID per week

78
Q

BV can cause

A

PROM and preterm

all women should be test and treated

79
Q

Retrograde menstruation

A

blood retracts into fallopian tubes and peritoneal cavity. Endom tissue can go up the brain and cause bleeding

80
Q

S&S of endometriosis

A 
pelvic pain
dyspaeruni
Painful menses and bowel movements
short menstrual cycles
can lead to infertitily
81
Q

Dx of endometriosis

A

laparoscopic exam

if cervix is in retroverted position (facing the back) and not movable (fixed) is a sing

82
Q

Tx of endometriosis

A

NSAIDS (decrease prostaglandin)
Danasol (supresses ovulation)
oral contraceptives: depoprovera (inhibits growth of endometrial tissue)
surgery to remove adhesions
Advise them to get preen right after surgery
Hysterectomy

83
Q

PID causative agents

A

Douching
gonorrhea
chlamydia
strep

84
Q

S&S of PID

A 
pelvic pain
fever
chills
vaginal discharge
CMT( cervical motion tenderness)
85
Q

Dx of PID

A 
Adnexal tendernes (tubes and ovaries)
Positive Chandelier sign (pain when cervix is moved)
Culture for chlamydia and gonorrhea
86
Q

tx of PID

A

Abx
Rocephin and doxycycline
erythromycin and zithromax

87
Q

TEach PID

A 
risk for infertility
tubal scarring
risk for ectopic pregnancy
IUDs are contraindicated
Change tampons q 4 hrs
Proper perineal care
88
Q

follicular ovarian cysts

A

when ovarian follicle fails to rupture during ovulation. next menstruation it regresses and hurts

89
Q

Luteal ovarian cyst

A

when corpus luteum fails to regress and it hurts a lot

90
Q

Tx for ovarian cysts

A

nothing
>6 cm surgery
oral contraceptives (suppress ovulation)

91
Q

S&S of ovarian cyst

A

Fullness of adnexal area
painful intercourse
irregular

92
Q

Dx of ovarian cyst

A

palpation or transvaginal sonogram

93
Q

Uterine fibroids S&S

A

menstrual cramping
menorrhagia (bleeding)
Painful

94
Q

Uterine fibroids etiology

A 
r/t estrogen and progesterone
>35
Black women
menarche before 12
nulipparity 
Obesity
95
Q

Dx of Uter. fib

A

Bimanual exam

transabdominal/vagnal sonogram

96
Q

Tx uterine fibroids

A 
NSAIDS
CAM
Oral contraceptives
RU486
hysterectomy
uterine artery embolization (not letting it grow)
they shrink in menopause
97
Q

if uterine fibroid and has baby

A

HEMORRHAGE AFTER BIRTH

98
Q

Factors that impair number and function of sperm

A

infection
varicocele
exposure to toxins
alcohol, marijuana and cocaine use

99
Q

Hystosalpingogram

A

dye injected into uterine cavity to determine latency of fallopian tubes

100
Q

Rubin technique

A

carbon dioxide is injected up the uterus.
if woman feels referred shoulder pain: GOOD SIGN. tubes are patent.
done after menses bc wanna make sure you aren’t pregnant

101
Q

Clomid

A

tx of infertility
used when woman is anovulatory
1st drug used. to induce ovulation. Stimulates release of FSH and LH
-risk for multiple births, ovarian enlargement (severe and pain)—must notify doctor
given for 3 months. if not working—-Pergonal

102
Q

Pergonal

A

IM injection
teach injection in buttocks
induces ovlation
hyperstimulation syndrome and multiple births risk

103
Q

Medical abortion

A

up to 8 weeks
pill or suppository
sonogram a week later to make sure products out

104
Q

Suction abortion

A

up to 12 wees

105
Q

Dilation abortion/D&C/curettage

A

after 12 weeks

cervix dilated. content scraped out and suctioned

106
Q

Incomplete abortion

A

need to do D&C

107
Q

threatened abortion

A

bleeding
backache
pelvic pressure
-instruct woman to get rest and take it easy.
NO COMPLETE BED REST. the abortion is inevitable.
Cervix is closed

108
Q

Inevitable abortion

A

bleeding and cramping
cervix dilated
sonogram to make sure no FHR
D&C done

109
Q

Management of abortions

A

r/o other causes for bleeding
sonogram
support groups
tell mother she didn’t dean abortion on herself
Monitor for infection, Hct and Hgb, hemorrhage,
give Rhogam

110
Q

Symmetrical IUGR

cause

A

proportionally small in all parts
-long term maternal or fetal genetic abnormality
chronic disease of mother: High BP (preeclampsia, eclampsia) malnutrition, poor diet, anemia, drugs.

111
Q

Dx of symmetrical IUGR

A

2nd trimester via sonogram/ultrasound

worse outcome than asymmetrical

112
Q

Asymmetrical IUGR

cause

A

disproportionally small
uteroplacental insufficiency (acute, short-term prob)
HBP, Preeclampsia in 3rd trimester.
grow to normal proportions by 1 year old

113
Q

Dx of asymmetrical IUGR

A

3rd trimester

114
Q

Associated problems with preterm neonate

A 
ROP-retinopathy of prematurity
RDS
BPD- bronchopulmonary dysplasia
NEC-Necrotizing entecolitis 
Cold stress
hyperbilirubinemia 
apnea
115
Q

Risk factors for necrotizing enterocolitis

A 
LBW
SGA
preterm/premature
formula fed
decreased gestational age
116
Q

S&S of necrotizing enterocolitis

A 
Abd distention
Vomiting
decreased BS
stool has occult blood
gastric residual food left in stomach
poor color
bowel looks dilated in Xray
resp difficulty
117
Q

Tx of necrotizing enterocolitis

A 
surgery
ostomy
NPO
IV fluids and abxs
NG tube for suction
Maintaining good thermal environment
118
Q

Effects of DM on pregnancy

A 
Hydramnios (leads to preterm, cord prolapse) due to fetal diuresis inc.
Gestational HTN
ketoacidosis
Stillborn
Hypoglycemia (1st trimester)
UTI
monilia
Dystocia
119
Q

Fetal neonatal effects of DM

A 
Congenital malformation (cardiac, neural tube, sacral a genesis)
Macro somos
Preterm birth
Birth trauma 
Perinatal death
Fetal asphyxia
RDS
Polythycemia
IUGR
hyperbilirubinemia 
Hypoglycemia
Hypocalcemia
120
Q

Fetal surveillance in diabetes

A 
Sonograms
AFP
fetal echocardiogram
NST-Bpp
Amnio
121
Q

Hypoglycemia S&S

A 
Shakiness
Sweating
Pallor, cold and clammy
Disoriented
Hunger
Headache 
Blurred vision
122
Q

Hyperglycemia S&S

A 
Fatigue
Flushed skin
Dry mouth, thirsty
Frequent urination
Rapid deep respirations 
Drowsiness
Depressed reflexes
123
Q

NI for cardiac disease pregn antepartum

A

High iron, protein and low fat diet
Avoid anemia and infections
Adequate sleep 8-10 hrs
Seen every 2 weeks first half of preg. Seen every week second half of preg.
Week 28-30 WATCH CLOSET FOR HIGHEST BLOOD VOLUME

124
Q

NI for cardiac intrapartum

A 
Lung sounds for rhales
Abxs
I&O
Side lying position
O2
Epidural recommended (pain ⬆️ CO)
Encourage short pushes 
No valsalva maneuver 
Forceps or vacuum
125
Q

NI for cardiac postpartum

A

First 48 hrs critical (4 days hospitalization) because of rapid fluid shift
Gradual progression of activity
Breast feed it not on 3rd or 4th

126
Q

Cause of infertility

A

STI
postponing pregnancy
Endocrine disorders

127
Q

Semen analysis

A

Sperm count (400 million)
Sperm motility
Sperm morphology

128
Q

Sims huhner test

Postcoital test

A

Tell pt to have sex right before ovulation

Then examine vaginal secretions to see if sperm can swim

129
Q

Threatened abortion management

A

Monitor other causes of bleeding, infection, hypovolemic shock, sonogram, blood levels

130
Q

Causes of ectopic pregnancy

A 
PID
STI
previous surgery there
Low estrogen 
Hormone imbalance 
IUD
131
Q

Etiology of Hyperemesis gravidarum

A

HCG
Emotional factors
Diet- poor eater; vit B6

132
Q

Partial hydatiform mole

A

Small uterus
2 sperm 1 ovum: too many chromosome
Not viable fetus
Spontaneous abortion

133
Q

Complete hydatiform mole

A 
Prune juice like bleeding 
Chorionic vili will grow 
Large uterus 
Sonogram 
14-16 weeks: thick brown prune discharge like bleeding

Maternity nursing 231 (5 decks)

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