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Semester Three - Half Two - Nursing 212 > Module 9 (Exam 3) Independent Study 1 > Flashcards

Module 9 (Exam 3) Independent Study 1 Flashcards

1
Q

Teratogen

A

Any agent that adversely affects normal growth and development of the embryo or fetus

  1. Infectious agents
  2. Drugs or other substances
  3. Environmental chemicals
  4. Radiation
  5. Maternal hyperthermia
  6. Effects of maternal morbidity
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2
Q

Greatest vulnerability to teratogens

A

2-8 weeks’ gestation (organogenesis)

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3
Q

Principles of teratongenicity

A
  1. Most vulnerable at 2-8 weeks gestation
  2. Greater potency and exposure = greater risk for embryonic/fetal injury
  3. Genetic pre-disposition = greater risk
  4. Fetal harm may result even in absence of maternal illness
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4
Q

Viral Agents

A
  1. Rubella
  2. Hepatitis B
  3. Cytomegalovirus
  4. Varicella Zoster Virus
  5. Herpes Simplex
  6. Human Immunodeficiency Virus (HIV)
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5
Q

Sexually transmitted infections

A
  1. Syphillis
  2. Gonorrhea
  3. Clamydia
  4. Trichomoniasis
  5. Condyloma Acuminatum
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6
Q

Medications

A
  1. Category A: no evidence of risk
  2. Category B: no studies in pregnant women
  3. Category C: Adverse implact in animals
  4. Category D:Evidence of human risk
  5. Category X: Absolute contraindications
  6. Eliminate drug or reduce dosage
  7. Substitute safer preparation
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7
Q

Alcohol or Illicit Drugs

A
  • No level of ETOH intake is considered safe during pregnancy
  • Illicit drugs place the developing fetus and are at high risk for impairments to normal development
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8
Q

Fetal Alcohol Spectrum Disorder

A
  • Hypothesized to be the leading cause of preventable birth defects
  • Prenatal and postnatal growth restriction
  • CNS/developmental abnormalities
  • Facial anomalies
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9
Q

Hyperthermia

A

Can be induced by hot tubs and saunas

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10
Q

Mechanical disruptions

A
  • Oligohydramnios
  • Uterine Malformations
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11
Q

Cytomegalovirus (CMV)

A

Member of the herpes group that is widespread and eventually infects most humans. Daycare centers are a common place for transmission of CMV. After primary infection the virus becomes latent and periodic reactivation and shedding of the virus may occur.

Transmission/Maternal Impact:

  1. Close contact with bodily fluids
  2. Organism crosses placental barrier
  3. Mother is often asymptomatic

Potential Fetal/Neonatal Impact:

  1. Risk is greatest when primary maternal infection occurs during prregnancy
  2. Most (90%) fetuses are not impacted
  3. 10% will present with CMV at birth
  4. Another 10% will develop learning disabilities or hearing impairment

Management:

  1. No effective chemical management for congenital infection

Nursing Implications:

  1. Prevention-based initatives
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12
Q

Rubella

A

Caused by a virus.

Transmission/Maternal Impact:

  1. Droplet Infection
  2. Direct Contact
  3. Organism crosses placental barrier
  4. Maternal signs and symptoms generally are mild

Potential Fetal/Neonatal Impact:

  1. SAB common with 1st trimester exposure
  2. Survival often accompanied by:
    1. Vision/Hearing Impairment
    2. Developmental/Cognitive Delays

Management:

  1. No effective chemical management for congenital infection
  2. Maternal MMR vaccine prior to pregnancy

Nursing Implications:

  1. Prevention-based initiatives
  2. Counsel avoidance of pregnancy X28 days after vaccination
    1. Live, attenuated virus
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13
Q

Hepatitis B (Hep B)

A

Transmission/Maternal Impact:

  1. Bodily Fluids
  2. Direct Contact during Birth
  3. Organism crosses placental barrier
  4. Risk of transmission rises as pregnancy progresses
  5. Maternal illness may be acute or chronic

Potential Fetal/Neonatal Impact:

  1. Preterm labor and birth
  2. Low birth weight
  3. Acute or chronic Hep. B infection
  4. Neonatal death

Management:

  1. Maternal Hep. B vaccine X3 (safe during pregnancy)
  2. Neonatal Hep. B immune globulin (HBIG) and initial Hep B vaccine within 12 hours of birth

Nursing Implications:

  1. Prevention-based initatives
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14
Q

Herpes Simplex Virus

A

Transmission/Maternal Impact:

  1. Transplacental infection is rare
  2. Most commonly transmits to fetus after ROM as virus ascends OR
  3. Vertical transmission during birth
  4. Mother may present with intial or recurrent infection

Potential Fetal/Neonatal Impact:

  1. SAB
  2. Preterm labor
  3. Intrauterine growth restriction: greatest risk when primary infection occurs during pregnancy
  4. High neonatal mortality rate with systemic infection

Management:

  1. Acyclovir (Zovirax) is safe during pregnancy but not CDC recommended
  2. C-section delivery in presence of active lesion(s)

Nursing Implications:

  1. Prevention and suppresion-based initivates
  2. Anticipatory guidance re potential for change in delivery method
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15
Q

Human Papilloma Virus (HPV)

A

Transmission/Maternal Impact:

  1. Vertical transmission during birth
  2. Organism rarely crosses placental barrier

Potential Fetal/Neonatal Impact:

  1. Evidence does not correlate HPV with birth defects

Management:

  1. Chemical management is not recommended during pregnancy
  2. Cryotherapy is considered safe
  3. Vaccination prior to pregnancy

Nursing Implications:

  1. Prevention-based initiatives
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16
Q

Varicella Zoster Virus (VZV)

A

Transmission/Maternal Impact:

  1. Droplet Infection
  2. Direct Contact
  3. Organism crosses placental barrier

Potential Fetal/Neonatal Impact:

  1. Low birth weight or intrauterine growth restriction
  2. Limb anomalies
  3. Greatest impact with exposure during 2nd trimester and just before or just after brith

Management:

  1. Mother and neonate: Varicella Zoster Immunoglobulin (VZIG)

Nursing Implications:

  1. Prevention-based initiatives
  2. Counsel avoidance of pregnancy X28 days after vaccination (live, attenuated virus)
17
Q

Human Immunodeficiency Virus (HIV)

A

Transmission/Maternal Impact:

  1. Bodily fluids
  2. Organism crosses placental barrier

Potential Fetal/Neonatal Impact:

  1. Congential HIV infection

Management:

  1. Zidovudine (AZT)

Nursing Implications:

  1. Prevention and suppresion-based initatives
  2. Ensure serologic screening during pregnancy
18
Q

Group B Strep (GBS)

A

Tranmission/Maternal Impact:

  1. Vertical transmission fro mother during birth
  2. 10%-30% of pregnant women harbor GBS
  3. Mother generally asymptomatic but maybe at risk for: UTI, chorioamnioitis, endometritis

Potential Fetal/Neonatal Impact:

  1. Leading cause of neonatal sepsis

Management:

  1. CDC: Screen all pregnancy women at 35-37 weeks’ gestation
  2. Stringent protocols for prophylactic antibiotics during labor
  3. Penicllin is first line
  4. Clindamyscin or vancomyscin for penicillin allergy

Nursing Implications:

  1. Antibiotic prophylaxis per protocol - not recommended for c-section unless post-ROM
  2. Careful surveillance of mother/fetus/babe
19
Q

Chlamydia

A

Transmission/Maternal Impact:

  1. Vertical transmission from mother during
  2. Mother may be asymptomatic
  3. May present with signs and symptoms of UTI, purulent vaginal discharge

Potential Fetal/Neonatal Impact:

  1. Associated with preterm labor and birth
  2. Neonatal conjunctivitis
  3. Pneumonia

Management:

  1. Maternal Azithromycin or amoxicillin
  2. Neonatal erythromycin (each eye at birth)

Nursing Implications:

  1. Prevention-based initiatives
20
Q

Syphillis (Treponema Pallidum)

A

Transmission/Maternal Impact:

  1. Direct contact with active lesion
  2. Organism crosses placental barrier

Potential Fetal/Neonatal Impact:

  1. Congenital syphillis

Management:

  1. Maternal and neonatal antibiotic therapy

Nursing Implications:

  1. Ensure serologic screening during pregnancy
21
Q

Bacterial Vaginosis (BV)

A

Transmission/Maternal Impact:

  1. Exact mechanism unknown

Potential Fetal/Neonatal Impact:

  1. Correlated with: preterm rupture of membranes, preterm labor, chorio, post partum endometriosis
  2. Increased susceptibility to other STIs

Management:

  1. Metronidazole or clindamycin (considered safe during pregnancy)
22
Q

Candidiasis

A

Transmission/Maternal Impact:

  1. Vertical transmission from mother during birth

Potential Fetal/Neonatal Impact:

  1. May contact oral thursh

Management

  1. Topically applied “azole” preparations
23
Q

Tichomoniasis (Trichomonas vaginalis)

A

Transmission/Maternal Impact:

  1. Sexual Contact

Potential Fetal/Neonatal Impact:

  1. Increased susceptibility to other STIs
  2. Correlated with preterm labor

Management:

  1. Single dose
  2. Metronidazole (considered safe during pregnancy)
24
Q

Toxoplasmosis (Protozoal agent)

A

Transmission/Maternal Impact:

  1. Organism crosses placental barrier
  2. Maternal infection following contact with contaminated soil, litter of infected cats, undercooked meats

Potential Fetal/Neonatal Impact:

  1. Congenital infection may cause neurologic compromise

Management:

  1. Chemical management of mother and neonate (varied ABX)

Nursing Implications:

  1. Prevention-based initiatives
25
Q

Urinary Tract Infection (UTI)

  • Cystitis
  • Pyelonephritis
A

Transmission/Maternal Impact:

  1. UTI correlated with preterm labor
  2. Pylonephritis: may require in house treatment
  3. Mother presents with: dysuria, urgency/frequency

Potential Fetal/Neonatal Impact:

  1. Risks associated with preterm labor and birth

Management:

  1. Sulfonamides (Bactrim)
  2. Amoxicillin/Augmentin
  3. Nitrofurantoin (Macrobid)

Semester Three - Half Two - Nursing 212 (41 decks)

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