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Maternity nursing 231 > High risk antepartum > Flashcards

High risk antepartum Flashcards

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
Secondary stage syphilis
``` 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 ```
26
Tertiary Stage syphilis
Involves multiple organs 1-50 years after first symptoms General psychosis, paralysis and death
27
Dx of syphilis
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
28
Tx of syphilis
Penicillin
29
If syphilis while pregnant
Spontaneous abortion Stillborn congenital syphilis (blindness, deafness and mental retardation)
30
HPV/ Condyloma Acuminata | types
6 &11: genital warts | 16&18: cervical cancer
31
HPV transmission
sexual contact and contact with warts themselves. Anal and genital areas
32
S&S HPV
asymptomatic | warts anywhere in perineal area
33
Dx of HPV
visual inspection and detailed pt Hx
34
Tx of HPV
``` most go away Only relieving symptoms Trichloric acid prilotherapy paladine Aldara cream ``` NO NEED FOR C-SECTION
35
Complications of HPV if had it during pregnancy
Laryngeal Papillomas in baby (warts in throat)
36
Prevention of HPV
``` 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 ```
37
Herpes Simplex Virus
Chronic, never goes away
38
Herpes type 1
Cold sores and blisters (face, lips, nose and chin) they come and go Pruritic and itchy Tx: Valtrex
39
Herpes type 2 Tx teach worst
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)
40
Dx of Herpes
Visualization of lesions viral culture of fluid blood for antibody titer
41
Tx of Herpes
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
42
Placenta Previa predisposing factors
C-sections Hx Multiparity Increased maternal age smoke and cocaine use
43
Complete placenta previa tx
need a c-section
44
Marginal Placenta previa/low lying | tx
within 3 cm of os | Vaginal birth is possible
45
Partial placenta previa tx
need a c-section
46
S&S of placenta previa
painless vaginal bleeding Uterus is soft, relaxed, nontender usually toward end of 2nd trimester and beginning of 3rd trimester.
47
Dx of Placenta previa
sonogram (14 weeks) may indicate low lying placenta but is normal and as it grows it is brought up. Come back for sonogram
48
Tx of placenta previa
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
49
HELLP Syndrome what do the words stand for? What is it?
``` Hemolysis Elevated Liver enzymes Low Platelets -Extension of severe preeclampsia ```
50
Etiology or HELLP
white multipara Preeclampsia <36th week (90%)
51
S&S of HELLP
``` 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 ```
52
Labs for HELLP
CBC platelet count Liver enzyme studies
53
Tx for HELLP
Prompt delivery no matter what age Fresh frozen plasma Packed RBC
54
Maternal risks of HELLP
Increased intraocular pressure: detached retina and blindness, cerebral hemorrhage and, stroke out and die
55
Fetal risks of HELLP
small baby SGA (vasospasm, vasoconstriction, poor perfusion | Hypermagnesemia (if given mg sulfate): decreased reflex, oliguria
56
Preeclampsia | what is it?
High BP and protein in urine that develops after 20 weeks of pregnancy.
57
Mild preeclampsia BP
<140/90 protein urine: 1 or +2 elevated liver enzymes lived edema
58
Tx of Mild preeclampsia
``` 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
Signs that mild preeclampsia is getting worse
visual disturbances severe headache GI pain, epigastric pain. liver enlargement
60
Severe preeclampsia BP
BP 160/110 or higher | Protein: 2 or 4+
61
S&S of severe preeclampsia
blurred vision r/t cerebral edema decreased urinary output facial and sacral edema
62
Tx of severe preeclampsia
``` 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
Epigastric pain with severe preeclampsia
sign that she is going not eclampsia!!
64
Mg Sulfate Normal levels toxicity
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
Risk factors for high BP while pregn
``` primipara existing DM Multigestations Young and old Hx of preeclampsia ```
66
Eclampsia can cause
Pt to go into labor and have precipitous birth | Poor placental perfusion and oxygenation
67
Complications of eclampsia
Cerebral hemorrhage: blurry vision/spots in eyes/hyperactive reflexes Decreased placental blood circulation: IUGR, Hypoxia
68
Tx of eclampsia
``` 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
HIV NI
``` 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
Baby born to HIV mother
Bactrim for 6 weeks to prevent pneumocystits pneumonia | r/o inf: 4 polymerase chain reaction test over 4 months (negative tests: no infection)
71
Yeast infection/monilia factors that increase it
``` pregnancy abxs Oral contraceptives douching diabetes Diabetes ```
72
monilia S&S
thick, curd like cottage cheese discharge painful intercourse dyrsuria red and painful labia and vulva
73
Dx of monilia
vaginal secretions wet mount | presence of hyphaed yeast buds
74
Tx monilia
terazol cream OTC monistat Diflucan (not for preg. 24 hrs to work)
75
Bacterial Vaginosis S&S
thin, grey discharge with fishy odor
76
Dx of bacterial vaginosis
wet mount: epithelial cells with edges all around due to bacteria sticking to them Add KOH to elecit + amine test: fishy odor
77
Tx of B.V
Flagyl BID per week
78
BV can cause
PROM and preterm | all women should be test and treated
79
Retrograde menstruation
blood retracts into fallopian tubes and peritoneal cavity. Endom tissue can go up the brain and cause bleeding
80
S&S of endometriosis
``` pelvic pain dyspaeruni Painful menses and bowel movements short menstrual cycles can lead to infertitily ```
81
Dx of endometriosis
laparoscopic exam | if cervix is in retroverted position (facing the back) and not movable (fixed) is a sing
82
Tx of endometriosis
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
PID causative agents
Douching gonorrhea chlamydia strep
84
S&S of PID
``` pelvic pain fever chills vaginal discharge CMT( cervical motion tenderness) ```
85
Dx of PID
``` Adnexal tendernes (tubes and ovaries) Positive Chandelier sign (pain when cervix is moved) Culture for chlamydia and gonorrhea ```
86
tx of PID
Abx Rocephin and doxycycline erythromycin and zithromax
87
TEach PID
``` risk for infertility tubal scarring risk for ectopic pregnancy IUDs are contraindicated Change tampons q 4 hrs Proper perineal care ```
88
follicular ovarian cysts
when ovarian follicle fails to rupture during ovulation. next menstruation it regresses and hurts
89
Luteal ovarian cyst
when corpus luteum fails to regress and it hurts a lot
90
Tx for ovarian cysts
nothing >6 cm surgery oral contraceptives (suppress ovulation)
91
S&S of ovarian cyst
Fullness of adnexal area painful intercourse irregular
92
Dx of ovarian cyst
palpation or transvaginal sonogram
93
Uterine fibroids S&S
menstrual cramping menorrhagia (bleeding) Painful
94
Uterine fibroids etiology
``` r/t estrogen and progesterone >35 Black women menarche before 12 nulipparity Obesity ```
95
Dx of Uter. fib
Bimanual exam | transabdominal/vagnal sonogram
96
Tx uterine fibroids
``` NSAIDS CAM Oral contraceptives RU486 hysterectomy uterine artery embolization (not letting it grow) they shrink in menopause ```
97
if uterine fibroid and has baby
HEMORRHAGE AFTER BIRTH
98
Factors that impair number and function of sperm
infection varicocele exposure to toxins alcohol, marijuana and cocaine use
99
Hystosalpingogram
dye injected into uterine cavity to determine latency of fallopian tubes
100
Rubin technique
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
Clomid
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
Pergonal
IM injection teach injection in buttocks induces ovlation hyperstimulation syndrome and multiple births risk
103
Medical abortion
up to 8 weeks pill or suppository sonogram a week later to make sure products out
104
Suction abortion
up to 12 wees
105
Dilation abortion/D&C/curettage
after 12 weeks | cervix dilated. content scraped out and suctioned
106
Incomplete abortion
need to do D&C
107
threatened abortion
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
Inevitable abortion
bleeding and cramping cervix dilated sonogram to make sure no FHR D&C done
109
Management of abortions
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
Symmetrical IUGR | cause
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
Dx of symmetrical IUGR
2nd trimester via sonogram/ultrasound | worse outcome than asymmetrical
112
Asymmetrical IUGR | cause
disproportionally small uteroplacental insufficiency (acute, short-term prob) HBP, Preeclampsia in 3rd trimester. grow to normal proportions by 1 year old
113
Dx of asymmetrical IUGR
3rd trimester
114
Associated problems with preterm neonate
``` ROP-retinopathy of prematurity RDS BPD- bronchopulmonary dysplasia NEC-Necrotizing entecolitis Cold stress hyperbilirubinemia apnea ```
115
Risk factors for necrotizing enterocolitis
``` LBW SGA preterm/premature formula fed decreased gestational age ```
116
S&S of necrotizing enterocolitis
``` 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
Tx of necrotizing enterocolitis
``` surgery ostomy NPO IV fluids and abxs NG tube for suction Maintaining good thermal environment ```
118
Effects of DM on pregnancy
``` Hydramnios (leads to preterm, cord prolapse) due to fetal diuresis inc. Gestational HTN ketoacidosis Stillborn Hypoglycemia (1st trimester) UTI monilia Dystocia ```
119
Fetal neonatal effects of DM
``` 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
Fetal surveillance in diabetes
``` Sonograms AFP fetal echocardiogram NST-Bpp Amnio ```
121
Hypoglycemia S&S
``` Shakiness Sweating Pallor, cold and clammy Disoriented Hunger Headache Blurred vision ```
122
Hyperglycemia S&S
``` Fatigue Flushed skin Dry mouth, thirsty Frequent urination Rapid deep respirations Drowsiness Depressed reflexes ```
123
NI for cardiac disease pregn antepartum
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
NI for cardiac intrapartum
``` 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
NI for cardiac postpartum
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
Cause of infertility
STI postponing pregnancy Endocrine disorders
127
Semen analysis
Sperm count (400 million) Sperm motility Sperm morphology
128
Sims huhner test | Postcoital test
Tell pt to have sex right before ovulation | Then examine vaginal secretions to see if sperm can swim
129
Threatened abortion management
Monitor other causes of bleeding, infection, hypovolemic shock, sonogram, blood levels
130
Causes of ectopic pregnancy
``` PID STI previous surgery there Low estrogen Hormone imbalance IUD ```
131
Etiology of Hyperemesis gravidarum
HCG Emotional factors Diet- poor eater; vit B6
132
Partial hydatiform mole
Small uterus 2 sperm 1 ovum: too many chromosome Not viable fetus Spontaneous abortion
133
Complete hydatiform mole
``` 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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