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Final exam OB/Medsurg > Medsurg/OB final > Flashcards

Medsurg/OB final Flashcards

1
Q

With continuous bladder irrigation, if the output is dark red, what do you do to the infusion?

A

Dark red = increase the rate

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2
Q

With continuous bladder irrigation, what should the output look like?

A

Light pink, few clots

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3
Q

How much drainage should be in the drainage bag for continuous bladder irrigation?

A

Drainage bag should be slightly more or equal to amount of solution infused

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4
Q

What are some risks with continuous bladder irrigation?

A

Infection – wash hands, empty bag when 1/2 full, keep ports sterile
Clot formation
Hemorrhage
Catheter obstruction– manually irrigate tubing

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5
Q

What is some teaching for a patient with continuous bladder irrigation?

A

Only take showers, no baths
Clean catheter site at least once a day with mild soap/water (pull downwards when cleaning)
No ointments or creams on catheter site
Drink at least 2L of water a day
Avoid alcohol + caffeine

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6
Q

When is continuous bladder irrigation used?

A

After TURP (transurethral resection of the prostate).

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7
Q

What age does benign prostate hyperplasia (BPH) affect?

A

Ages 40 and older

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8
Q

What are signs/symptoms of BPH?

A

Increased urinary frequency
Urine dribbling
UTI’s
Increased urinary urgency

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9
Q

What are risk factors of BPH?

A

Smoking
ETOH use
Obesity
Heart disease
Diabetes

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10
Q

With BPH, what would the results be from a DRE and PSA level draw?

A

DRE= large, rubbery, non-tender prostate gland
PSA level= above 4.0

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11
Q

What are medications used to treat BPH?

A

Tamsulosin = relax prostate
Finasteride = prevent conversion of Testosterone to DHT

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12
Q

What age does prostate cancer affect most men?

A

50 and above

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13
Q

What are some risk factors for prostate cancer?

A

African American heritage
Increased age
High fat/red meat diet
Family history of prostate cancer

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14
Q

What are some signs/symptoms of prostate cancer?

A

Increased difficulty and frequency of urination
Urinary retention
Hematuria
Painful ejaculation
Sexual dysfx

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15
Q

For prostate cancer, what would a DRE and a PSA look like?

A

DRE= stoney-hard/fixed lesion
PPSA level = > 4.0

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16
Q

What is TURP used to resolve?

A

Prostate Cancer and BPH

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17
Q

What are two treatment options for prostate cancer?

A

Prostatectomy and Androgen Deprivation Therapy (can cause hypogonadism/gynecomastia)

Orchiectomy = surgical removal of 1 or both testes

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18
Q

What are some nursing interventions for a patient with prostate cancer?

A

Administer opioid + non opioid analgesics for bone pain
Advise of erectile dysfx possibility following surgery
CAUTI education
Infection prevention

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19
Q

What is TURP syndrome?

A

Hypervolemia/Hyponatremia
- D/C irrigation
-Admin diuretics
-Change irrigation to 0.9% NS
-Monitor I/O
-Assess heart and lung sounds

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20
Q

What age does testicular cancer primarily affect?

A

Men aged 18-35

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21
Q

What are risk factors for testicular cancer?

A

Cryptorchidism
Caucasian American
HIV +
Exposure to environ. chemicals

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22
Q

How do you prevent testicular cancer?

A

TSE = Testicular Self Examination

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23
Q

When is the best time to perform a TSE & how often should they be done?

A

After warm bath/shower
Every month

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24
Q

What are signs/symptoms of testicular cancer?

A

Painless enlargement of testis
Heaviness in scrotum/groin/abdomen

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25
Q

What labs would be look for in testicular cancer?

A

AFP ( increased )
Beta HCG (increased )
Chest X ray (lung metastases)
Ultrasound/CT/MRI

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26
Q

What are a few treatment options for patients with Testicular cancer?

A

Orchiectomy (removal of testis)
Radiation
Chemotherapy

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27
Q

What are some things the nurse will want to review with a patient who is diagnosed with testicular cancer?

A

Banking sperm due to infertility
Address issues related to body changes/sexuality
Stop smoking, no ETOH, healthy diet
Birth Control use for 18-24 months following chemotherapy
Continue TSE monthly

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28
Q

What are some risk factors of urolithiasis?

A

Male gender
BPH
Dehydration
Urinary retention

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29
Q

A patient reports lower back/flank pain that comes in waves. They have a fever, hematuria, and very sweaty. Based on these signs/symptoms, what is a likely diagnosis?

A

Renal calculi

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30
Q

What are some considerations for a patient with urolithiasis?

A

Increase fluids ( 3L a day)
Increase ambulation
Strain urine
Tamsulosin (Flomax)

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31
Q

What should a patient with urolithiasis avoid?

A

Bed rest or massages

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32
Q

What bacteria is a common cause of glomerulonephritis?

A

Strep!

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33
Q

What would the urine and body look like in a patient with glomerulonephritis?

A

Frothy and cola-colored urine (due to proteinuria and hematuria)
Eyelid and angioedema (due to decreased albumin)
Headache/HTN

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34
Q

What is the difference between nephrotic syndrome and nephritic syndrome?

A

Nephrotic is without hematuria (no blood in urine) only protein (frothy/bubbly urine)

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35
Q

In glomerulonephritis, with the increased swelling/edema, what is one thing we must do for the abdomen?

A

Measure abdominal girth

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36
Q

With glomerulonephritis, what would labs look like? What labs would be drawn?

A

BUN & Creatinine (increased)
GFR (low)
Albumin (increased)
Antistrepolysin Titer ( + )

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37
Q

What is the treatment for glomerulonephritis?

A

Antibiotics
Corticosteroids
Diuretics + Antihypertensives
Albumin replacement
*Monitor K+ levels

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38
Q

What is a common cause and common concern for a patient with pyelonephritis?

A

Cause: Unresolved UTI’s
Concern: AKI

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39
Q

A patient comes in with a fever, flank pain/tenderness, N/V and is tachypnic. What is the likely diagnosis?

A

Pyelonephritis

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40
Q

What does pyelonephritis and glomerulonephritis have in common?

A

Both would show an increase in WBC

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41
Q

What can an AKI be caused by?

A

Pre-renal
Intra-renal
Post-renal injuries

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42
Q

What is the normal urinary output expected in adult patients?

A

30 mL/ hr
1-2 L a day

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43
Q

What are some signs/symptoms of AKI?

A

Oliguria ( < 400 mL/day)
Numbness/Tingling
Kussmaul respirations (metabolic acidosis)
Itching
FVE

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44
Q

How do we differentiate AKI from dehydration?

A

Fluid challenge test

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45
Q

What are some causes of CKD?

A

Chronic glomerulonephritis/pyelonephritis
DM
Hypertension
Nephrotoxic drugs

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46
Q

What are some signs/symptoms of a patient with CKD?

A

Headache
Anemia (due to RBC filtering out of kidney)
Proteinuria/Hematuria
Increased BP + K+
Increased weight/Edema
SOB

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47
Q

What are some treatment options for a patient with CKD?

A

Hemodialysis
Peritoneal dialysis
Vitamin C & D
Erythropoietin
Oxygen
BP meds (Ace inhib “-pril” or ARBS “-sartan”)

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48
Q

What type of diet should a patient with CKD be on?

A

Low protein, low Na+

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49
Q

What are the 4 phases of AKI?

A
  1. Oliguric ( <400 mL/day)
  2. Diuresis (> 400 mL/day) (1-3 weeks)
  3. Recovery (GFR returns to normal) ( 1yr + )
  4. Chronic Kidney Disease
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50
Q

What is the pathophysiology fir Amyotrophic Lateral Sclerosis?

A

Loss of motor neurons in spinal cord and brainstem causing
–Increased ( + ) Glutamate causing hyperexcitability
–Progressive muscle weakness

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51
Q

What body system is not affected in a patient with ALS?

A

Bladder and rectum/GI

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52
Q

What do Riluzole and Edavarone do and what disease are they for?

A

ALS
Edavarone- slows fx decline
Riluzole- slows deterioration of neurons

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53
Q

How is ALS diagnosed?

A

Electromyography
Muscle biopsy (decrease in fx motor units)
MRI- high signal intensity in corticospinal tracts

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54
Q

What neurotransmitter is decreased in Myasthenia Gravis?

A

Acetylcholine (causing muscle weakness)

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55
Q

When should medications for a patient with myasthenia graves be administered?

A

30-60 minutes before meals.

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56
Q

Explain the tensilon test. Purpose, procedure, outcomes

A

Purpose- Dx myasthenic crisis or cholinergic crisis
Procedure- Endrophonium administered
Outcomes- symptoms improve, pt is in myasthenic crisis. If not, pt in cholinergic crisis
(prepare as code, heart monitor necessary, Atropine at bedside)

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57
Q

What is administered to a patient in a confirmed cholinergic crisis?

A

Atropine! Prepare procedure as code. Heart monitor is necessary

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58
Q

What is the surgical treatment and medical treatment for a patient with myasthenia gravis?

A

Thymectomy (Acetylcholine antibodies released there)
Pyridostigmine + Neostigmine
Corticosteroids
Immunosuppresants

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59
Q

What neurotransmitters are affected in Parkinson’s disease?

A

Decrease in Dopamine
Increase of Acetylcholine

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60
Q

How is Parkinson’s disease diagnosed?

A

Over time with signs/symptoms. At least 3 must be noted

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61
Q

What is carvidopa + levodopa (sinemet) used for? Why is Entacapone included?

A

Parkinsons Disease
Levodopa crosses BBB
Entacapone allows Sinemet to last longer

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62
Q

What are some symptoms of parkinsons disease?

A

Cogwheel rigidity
Shuffling gait
Pill rolling
Expressionless face
Dystonia
Tremors at rest

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63
Q

What is the pathyphysiology for multiple sclerosis?

A

Autoimmune disease that affects the myelin sheath of the CNS. Inflammation and scarring of nerve creates lower nerve transmissions

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64
Q

What makes the symptoms of a patient with multiple sclerosis worse?

A

Heat/Infection/Stress/Overexertion

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65
Q

Name a few signs/symptoms of a patient with multiple sclerosis.

A

+ Rombergs sign
Lehrmittes sign (pain when moving neck)
Cognitive changes
Dizzy/diploplia
Dysarthria

66
Q

What diagnostic procedure is performed in a patient with multiple sclerosis and what is the expected result of that procedure?

A

Cerebrospinal Fluid test (CSF)- Increase in IgG levels and protein

67
Q

What are some treatment options for a patient with multiple sclerosis?

A

Interferon Beta 1a or 1b
(Avonex or Betaseron)
Corticosteroids
Glatiramer (Copaxone) (Immunomodulator-admin SQ)

68
Q

What is a normal Hemoglobin and Hematocrit?

A

Hemoglobin
M- 14-18
F- 12-16
Hematocrit
M- 42-52%
F-37-47%

69
Q

What is a normal WBC and platelet count?

A

WBC: 5-10,000/mm3
Platelet: 150,000-400,000/mm3

70
Q

What does a low WBC and platelet count indicate?

A

WBC- immunosuppression
Platelet-Thrombocytopenia

71
Q

What are manifestations of a patient with Iron deficiency anemia?

A

SOB
PICA
Pallor
Smooth/red tongue
Angular cheliosis

72
Q

What are treatments and education for a patient with iron deficiency anemia?

A

Increase iron intake in diet/supplements, or IV ferrous sulfate

Iron causes GI upset
Take iron with Vitamin D to promote absorption
Use straw with oral iron due to staining teeth

73
Q

What are some foods high in iron?

A

Beans, leafy veggies, lentils

74
Q

What are nursing priorities for a patient with sickle cell anemia?

A

Pain management
Oxygen
Infection prevention
Fluids to maximize hydration + tissue perfusion

75
Q

Who is at risk of sickle cell anemia?

A

African American males
Middle eastern/mediterranean
Tribal populations in India

76
Q

Why is sickle cell anemia so serious?

A

Sickle shaped cells can pool in organs, occlude vessels, cause necrosis, and be very painful!

77
Q

What is the cure for a patient with pernicious anemia?

A

Cycanobalan (IM B12 injection) b/c they lack intrinsic factor to absorb B12 via oral route

Could be caused by GI surgeries/issues, metformin/antacid/histamine uses

78
Q

What are signs/symptoms of pernicious anemia?

A

Jaundice
Fatigue
ALOC
Vitiligo
Smooth/sore red tongue

79
Q

What are risk factors for vitamin B12 deficiency?

A

Vegan diet, Pancreas & ileum diseases, impaired absorption in GI tract

80
Q

What is the treatment for vitamin b12 deficiency?

A

Oral vitamin B12
Oral supplements with vitamins
Fortified soy milk

81
Q

What is “Charcots Triad” and what disease process is this related to?

A

-Jaundice
-Fever
-RUQ pain
Choleangitis

82
Q

What is the difference between cholelithiasis and choledocolithiasis?

A

Cholelithiasis- Stones in gall bladder
Choledocolithiasis- Stone in bile duct

83
Q

What is one complication of choledocolithiasis?

A

Pancreatitis due to common bile duct obstruction
Choleangitis (inflammation)

84
Q

What are signs/symptoms of cholelithiasis?

A

Jaundice/grey stools
RUQ pain, abdomen distension
Dark urine
Pain after fried/fatty meals

85
Q

What are treatment options for Cholelithiasis and Choledocolithiasis?

A

ERCP/Lithotripsy to break up gallstones
IVF to flush out stones
Cholecystectomy

86
Q

What would labs show in a patient with cholelithiasis or choledocolithiasis?

A

Bilirubin- Increased
WBC- Increased
PTT- Increased
H&H- Decreased
Vit. K- Decreased

87
Q

What are nursing considerations for a patient with cholelithiasis or choledocolithiasis?

A

Rest
Analgesics
Low fat diet/low cholesterol
Semi fowlers position
Antibiotics

88
Q

What is the difference between Cholecystistis and Choleangitis?

A

Cholecystitis- Inflammation of gallbladder
Choleangitis- Inflammation at site of obstruction (common bile duct)

89
Q

What are signs/symptoms of cholecystitis and choleangitis?

A

Severe RUQ pain/epigastric pain referred to R shoulder/flank, clay colored stool, dark urine, diaphoresis, jaundice

90
Q

What is the function of the liver?

A

A- Albumin
B- Bile
C-Clotting factors

91
Q

What are signs/symptoms of cirrhosis?

A

Jaundice
Skin lesions
Ascites (r/t decreased albumin)
Fatigue
Hepatic encephalopathy
Edema
+ Chvostek sign
+ Trousseau sign

92
Q

What would lab testing for a patient with cirrhosis look like?

A

Bilirubin- Increased
Ammonia- Increased
PTT- Increased
Albumin- Decreased
Blood Glucose- Decreased

93
Q

What are signs/symptoms of pancreatitis?

A

Severe LUQ pain radiating to left shoulder/back
Cullens sign (around umbilicus)
Turners sign (on side)
Tetany (r/t decrease ca)
Jaundice

94
Q

What diet should a patient with pancreatitis be on?

A

NPO — gradually increase to a bland or low fat diet

95
Q

What would labs look like in a patient with pancreatitis?

A

Amylase- Increased
Lipase- Increased
WBC- Increased
Bilirubin- Increased
Glucose- Increased (insulin being released in bloodstream)
Platelets- Decreased

96
Q

What medications would a patient with pancreatitis be recommended?

A

Digestive enzymes (pancrelipase, saliva substitute [Salivart])
Opioid Analgesics
IV fluids
Insulin
Antiemetics

97
Q

What size gauge needs to be used for a blood transfusion?

A

22 gauge or larger ( 18G, 16G, etc)

98
Q

How long should you remain with a patient when administering a blood transfusion?

A

First 15 minutes
Start transfusion slow (5mL/min)

99
Q

How long do you have to initiate the blood transfusion after collecting the blood from the blood bank?

A

30 minutes

100
Q

How long do you have to transfuse your blood completely?

A

4 hours after being hung
(change tubing after every 2 units)

101
Q

What are signs of a transfusion reaction?

A

Fever, chills, respiratory distress, low back pain, nausea, pain at IV site, “feeling unusual”

102
Q

What do you do in the event of a blood transfusion reaction?

A
  1. Stop transfusion
  2. Asses patients vitals
  3. Notify PCP
  4. Notify blood bank
  5. Send blood container and tubing to blood bank for repeat typing & culture
103
Q

Why do you need a 2nd RN around for a blood transfusion?

A

They need to verify the labels, cross type and match, patient identification

104
Q

What are signs/symptoms of metabolic acidosis?

A

Headache, confusion, increased respiration and depth, cold/clammy skin, cardiac arrhythmias

105
Q

What is the treatment for metabolic acidosis?

A

Administration of Bicard
Hemodialysis
Peritoneal Dialysis

106
Q

How does the respiratory system compensate for metabolic acidosis?

A

Hyperventilation (release CO2)
Charcoal
Insulin
Diuretics

107
Q

What are signs/symptoms of metabolic alkalosis?

A

Tingling of the fingers/toes, Dizziness, tetany

108
Q

What are causes of metabolic alkalosis?

A

Severe vomiting/gastric suctioning, diuretic therapy, bushings disease, intake of milk/calcium carbonate, K+ depletion

109
Q

What are causes of metabolic acidosis?

A

Diarrhea, renal insufficiency/failure, lactic acidosis, aspirin poisoning, starvation, DKA

110
Q

What are treatment options for metabolic alkalosis?

A

Fluids
PPI
Anti-emetic
Carbonic Anyhydrase Inhibitor

111
Q

How does the respiratory system compensate for metabolic alkalosis?

A

Hypoventilation (decrease RR)

112
Q

What are causes of respiratory acidosis?

A

Inadequate ventilation, pulmonary edema, pneumothorax, sleep apnea, acute respiratory distress, COPD, ALS, MS, MG

113
Q

What are signs/symptoms of respiratory acidosis?

A

Increase pulse
Decrease BP
Decrease RR
ALOC
Increased ICP (headaches)
Cyanosis
Tachypnea

114
Q

What are treatment options for respiratory acidosis?

A

Bronchodilators
Antibiotics for infection
Nebulizer/supplemental O2
Possible Narcan/thrombolytics/anticoags
Hydration (to loosen mucus)

115
Q

What are nursing interventions for a patient with respiratory acidosis?

A

Pursed lip breathing
Encourage coughing
Encourage deep breathing

116
Q

What are signs/symptoms of a patient with respiratory alkalosis?

A

Hyperventilation
-Lightheadedness
-ALOC
-Numbness/tingling
-Tinnitus
-Tachycardia
-Arrhythmia

117
Q

Panic disorders, hypoxemia, aspirin intoxication, sepsis, inappropriate ventilator settings and hypokalemia are all causes of what?

A

Respiratory Alkalosis

118
Q

How do we treat respiratory alkalosis?

A

Breathing techniques (paper bag breathing, box breathing, 4-7-8 method)
Antianxiety agents
K+

119
Q

What is the difference in diagnostics of DI and SIADH?

A

DI- Low H20, Low ADH
SIAHD- High H20, High ADH

120
Q

Compare the labs of someone with DI vs SIADH.

A

DI
ADH- low
Serum Osmo- high (>300)
Urinary output- low
Na+ - High
USG- Low

SIADH
ADH- high
USG- high
Serum osmo- low (<280)
Urine output- low

121
Q

What is a diagnostic test used for diabetes insipus?

A

Water restriction test-
Patient will still be urinating hourly after water restriction
*Hourly assessments
**If pt becomes hypotensive & tachycardia, STOP test

122
Q

What medications are used for diabetes insipidus?

A

Diabinese/Chlorpropramide
(watch for hypoglycemia)
Desmopressin/DDVP [Vasopressin]
(watch for hyponatremia/water intoxication) **Quick increase of BP, vasopressin shunts blood to organs

123
Q

What are treatment options for SIADH?

A

Loop diuretics
Hypertonic IV solutions
Declomycin/Conivaptan/Tolvaptan (ADH inhibitor)

124
Q

What are signs/symptoms of SIADH vs DI?

A

SIADH:
Hyponatremia (seizure/muscle cramping)
Decreased urine output (dark urine)
FVE (lung crackles)
Tachycardia
Thirsty

DI:
Polyuria (5-20L a day) (250mL/hr)
Polydipsia (VERY thirsty)
Decreased BP, Increased HR
Dehydration(dry mucous membranes, poor skin turgor)

125
Q

Where is ADH released from?

A

Posterior pituitary (base of brain)

126
Q

Where are glucocorticoids released from? (Cushings/Addisons)

A

Anterior Pituitary (base of brain)

127
Q

What are the requirements to be diagnosed with diabetes?

A

Fasting plasma glucose:
> 126 mg/dL
Oral glucose test:
> 200 mg/dL
Hemoglobin A1C
> 6.5%
Casual Plasma Glucose
> 200 mg/dL

128
Q

What is the pathophysiology for diabetes? T1 and T2?

A

T1- Destruction of pancreatic beta cells.
( - ) Insulin production & ( + ) glucose production by liver

T2- Insulin resistance
Impaired insulin secretion
Decreased sensitivity

129
Q

What are treatments for DKA and HHS?

A

0.9% or 0.45% NS
Insulin with dextrose
(only regular insulin administered via IV)

130
Q

What is the dawn phenomenon?

A

Morning hyperglycemia

131
Q

What is the somogyi phenomenon?

A

Early morning hypoglycemia (2-3am)

132
Q

What are some items to advise the patient regarding recent diagnosis of diabetes?

A

Alcohol & Exercise will decrease BG
Foot & eye care
Higher risk of infection
Surgery/stress/illness/infection will increase BG

133
Q

In a patient with Type 2 DM, when should they take their oral antihyperglycemics?

A

Up to 30 minutes before meals

134
Q

Name the rapid acting insulins & when food should be given

A

Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
**Eat within 5-15minutes after admin

135
Q

Name the short acting and intermediate acting insulin and when food should be given.

A

Short acting- Regular
(eat within 15 minutes)
Intermediate acting- NPH
(eat around onset-peak; 1-4 hrs)

136
Q

What are the long acting insulins?

A

Glargine (Lantus)
Deter (Levemir)
Onset: 3-6 hrs, no peak

137
Q

Compare the signs/symptoms of hypoglycemia and hyperglycemia/

A

Hypo:
Nervousness/confusion
Sweating/drowsiness
Slurred speech
Tachycardia
Hunger
“Cold & Clammy, needs some candy!”
Hyper:
Dry mouth
Blurred vision
Thirst/dry mouth
Deep, rapid breaths
Frequent urination
“Hot & dry, sugars high!”

138
Q

What is the purpose of an amniocentesis?

A

Detect chromosomal abnormalities and hereditary metabolic defects. (confirm fetal abnormalities)

Requires an amniotic sac puncture & fluid analysis (fern test, blue nitrizine strip)

139
Q

What medications would you administer for a post partum hemorrhage?

A

Oxytocin (Pitocin)
Misoprostol (Cytoctec) no cardiac issues
Dinoprostone (Prostin E2) no cardiac issues
Methergine not for pt with HTN
Prostaglandin (Cervidil)
Hemabate not for pt with asthma

140
Q

Name the nursing interventions for a post partum hemorrhage

A
  1. IV fluids
  2. Fundal massage
  3. Admin uterotonic medications
  4. Weigh pads
  5. Bimanual compression/Internal uterine packing/balloon tamponade
    (vitals Q 15-30 min)
141
Q

Name the risk factors for post partum hemorrhage.

A

Uterine atony
Lacerations
Retained placenta fragments
Inversion of the uterus
Placenta Accreta
Hematomas
Coagulation disorders
LGA newborns
Induction of labor w/ oxytocin
Surgical births
Prolonged labor

142
Q

How might a patient experiencing post partum hemorrhage appear?

A

Low BP, high HR
Quickly saturating pads
Boggy/spongy fundus

143
Q

Complete the VEAL - CHOP acronym along with interventions for each letter.

A

Check with page in binder

144
Q

Name some red flags of a sex trafficking victim.

A

Older boyfriend
New/expensive items
Separation from friends/family
Inconsistent injuries/explanations
Avoiding eye contact
Not wanting to provide personal info
Sudden academic decline
*Immigrant women/children with low education

145
Q

Name some red flags for a pimp.

A

Easily jealous
Controlling/violent
Demanding about sex
Always knows how to make lots of money

146
Q

Provide baseline baby vitals.

A

O2: 92% or above
Temp: 36.5-37.5
HR: 110-160
RR: 30-60
BG: 40

147
Q

What is an amniotomy used for?

A

Deliberately rupturing membranes

148
Q

How is an amniotomy performed?

A

Inserting a cervical hook (Amniohook) through the cervical os to deliberately rupture the membranes

149
Q

What are risks associated with amniotomy?

A

Umbilical cord prolapse/compression
Maternal/Neonatal infection
FHR deceleration
Bleeding
Client discomfort

150
Q

What color should amniotic fluid be? What does cloudy or green fluid mean?

A

Amniotic fluid should be clear

Green=Fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, (IUGR), maternal HTN, diabetes, or chorioamnionitis

Cloudy/foul smelling= infection

151
Q

What is important to check following an amniotomy?

A

FHR
Amniotic fluid characteristics

152
Q

What are risk factors for amniocentesis?

A

Lower abdominal cramping (up to 48 hrs after procedure) (fetal loss)
Spontaneous abortion
Maternal/ fetal infection (fever)
Postamniocentesis chorioamnionitis
Fetal–maternal hemorrhage
Leakage of amniotic fluid

153
Q

What is done following an amniocentesis procedure?

A

Pressure applied to site. No bleeding=sterile bandage
Possible RhoGAM admin
Assess maternal/fetal vital signs & FHR every 15 min-1hr post procedure
Observe the puncture site for bleeding/ drainage

154
Q

What are signs/symptoms of preeclampsia?

A

HTN (160/110)
Proteinuria
Headache
N/V
Blurred vision
Hyperreflexia

155
Q

How is preeclampsia managed?

A

No severe features:
Monitor BP + kick counts
Lay in lateral recumbent position
Diet w/o Na+ restriction + 6-8 oz glasses of water
Daily low dose aspirin

Severe features:
Aspirin therapy
Betamethasone (34 weeks or less)
Mg. Sulfate + Oxytocin
Antihypertensives

possible early delivery

155
Q

What are the signs of Mg. Sulfate toxicity? What is the antidote?

A

Signs/Symptoms:
Diminished/absent reflexes (hyporeflexia)
Decreased RR
Oliguria
Serum Mg: >8 mg/dL

Antidote: Calcium gluconate

156
Q

How is Magnesium Sulfate given?

A

IV in fusion pump.
Loading dose: 4-6g over 15-30 min.
Infusion: 1-2g/hr as continuous infusion

157
Q

What is endometriosis? Signs and symptoms?

A

Endometrosis is a chronic inflammatory process where tissue implants outside of the uterus. (Increased risk of ectopic pregnancy)

Signs/Symptoms:
Infertility/Pelvic pain Painful menstruation/urination/intercourse
Painful bowel movements
Heavy menses
Irregular/frequent menses
Depression/Fatigue
Vaginal spotting/back pain

158
Q

How is endometriosis diagnosed?

A

Pelvic exam-non specific pelvic tenderness
Laparoscopy- tissue biopsy
Pelvic/transvaginal ultrasound- rule out cysts/fibroids

159
Q

What are nursing interventions for endometriosis?

A

Healthy lifestyle habits (diet, exercise, sleep, stress)
Support groups
Surgeries
Medications
(NSAIDS
Oral Contraceptives
Progestogens (Medroxyprogesterone)
Antiestrogens (Tamoxifen)

160
Q

What is the temperature to watch for following a delivery?

A

> 100.4

Final exam OB/Medsurg (1 decks)

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