ob final Flashcards

Question 1

Q

Nursing Interventions for Newborn(First Two Hours Recovery)

Answer

A

○ Newborn assessment q30 (fundal assessment and vital signs) ○ Administer erythromycin/vitamin K (eyes/thighs or E/T) ○ Assist with breastfeeding ○ Apgar scoring, weigh, measurements, security bands, education ○ Assist with bonding and feeding initiation

Question 2

Q

Nursing Interventions for Patient: (First Two Hours Recovery)

Answer

A

○ Start postpartum Pitocin (Oxytocin) ○ Maternal assessments q15 for 1st hour then q30 for 2nd hour (fundal assessment and vital signs) ○ Pericare, pain medication, comfort measures, assist to bathroom, education

Question 3

Q

2-12 hours Postpartum General Protocols: Post-Vaginal Birth

Answer

A

b ● VS and fundal checks q8-12 ● Motrin and Tylenol● If epidural, as soon as wears of

●If no epidural, up to bathroom & ambulating right away

●If epidural, as soon as wears off

○May have urinary retention upon first void

●VS and fundal checks q8-12

●Motrin and Tylenol

○ May have urinary retention upon first void ● VS and fundal checks q8-12 ● Motrin and Tylenol ○ May have urinary retention upon first void ● VS and fundal checks q8-12 ● Motrin and Tylenol

Question 4

Q

Post-Cesarean Birth:

Answer

A

●Bedrest for ~12 hours●Foley catheter●IV fluids infusing●VS and fundal checks q4●Motrin/Toradol and/or PO narcotic

Question 5

Q

Uterus Assessment: Subinvolution Definition

Answer

A

●a disruption in the normal involution process

○Immediate or delayed; can cause a postpartum hemorrhage or occur due to retained placenta

Question 6

Q

Why does patient position matter when the RN is completing a fundal massage?

Answer

A

More accurate: as umbilical will be in a different location. Place patient supine

Question 7

Q

Why do we care about a full bladder?

Answer

A

It will get in the way of fundus contracting.

Question 8

Q

BUBBLELE: Bowel

Answer

A

●May take up to 3 days before the first bowel movement postpartum

○First 3 days: encourage ambulation, fluids, increase fiber-rich foods, stool softener

○3+ days without a bowel movement: discuss with provider alternatives; consider laxative in PO or suppository form and/or enemas

●Assess presence of flatus: gas

●Post-op cesarean patients can experience trapped gas

○Important to encourage clear liquids first before a large meal postpartum

●Hemorrhoids may have been present in pregnancy

○Often aggravated with pushing in a vaginal delivery

Question 9

Q

BUBBLELE: Lochia

Answer

A

●Cervical os slowly closes postpartum

●Passing of menstrual-like blood until ~6 weeks postpartum

●Bleeding should slow and follow this pattern. If does not, could be a sign of a complication

○Lochia rubra: Days 1-3, bright red, small clots

○Lochia serosa: Days 4-10, brown/pink

○Lochia alba: Day 10+, yellow/white

●Color and consistency of blood gives insight into origin

Question 10

Q

Perineal Lacerations: Nursing Interventions

Answer

A

●Decrease infection

●Pain control

●Decrease pressure/straining

●Ensure referral to urology/pelvic floor PT

Question 11

Q

BUBBLELE: Emotional Status:

Answer

A

Baby blues: ~80% of patients experience

■Transient feelings of sadness, bouts of crying, overwhelm

■Lasts about 1 week

Question 12

Q

Rubin’s Model of Maternal Postpartum Adjustment:

Answer

A

●Taking in (dependent phase)○1st 24 hours○Focused on self and basic needs, excited, talkative, reviewing birth experience

●Taking hold (dependent/independent phase)○Lasts 10 days-several weeks○Focused on new role, optimal time for teaching and learning

●Letting go (interdependent phase)○New parent role is accepted, reestablishing relationship with partner, accepting of family unit

Question 13

Q

Other Postpartum Physiologic Changes: Hormonal

Answer

A

Hormonal Changes:

●Dramatic decrease in estrogen and progesterone

●Lactational amenorrhea related to increase in prolactin and oxytocin with breastfeeding

Question 14

Q

Other Postpartum Physiologic Changes: Pelvic Floor

Answer

A

●Abdominal tone may take ~6 weeks or more to return

●Diastasis recti: abdominal separation that occurred to accommodate growing fetus can occur in pregnancy and take time to improve/resolve

●Decreased control over urinary and rectal sphincters may occur immediately postpartum

●Kegel exercises and abdominal breathing can start immediately after delivery

Question 15

Q

What is the first expected change in vital sign in a patient who is having increased bleeding?

Answer

A

Increased Heart Rate

Question 16

Q

1st T: Tone (Uterine atony):

Answer

A

●Risk factors: full bladder, large uterus, high parity

●Assessment: boggy uterus; excessive bleeding

●Intervention: fundal massage, uterotonic medications

Question 17

Q

2nd T: Tissue (Retained placenta)

Answer

A

●Risk factors: preterm delivery, placental abnormalities

●Assessment: boggy uterus; excessive bleeding

●Intervention: Assess for and remove retained products

Question 18

Q

3rd T: Trauma (Lacerations, episiotomy, hematoma

Answer

A

●Risk factors: precipitous deliveries, OASIS, operative deliveries, macrosomia, abnormal presentation, labial varicosities

●Assessment: firm fundus, steady stream of bright red bleeding, bluish swelling near perineum; intense perineal/rectal pain/pressure

●Intervention: assess the site, hematoma evacuation

Question 19

Q

4th T: Thrombin (Coagulopathy)

Answer

A

●Risk factors: coagulopathy, placental abruption, OB emergency

●Assessment: bleeding from IV sites/nose

●Intervention: treat underlying cause, transfusions

Question 20

Q

Uterotonic Medication: (know route/and generic name)

Answer

A

●Oxytocin (Pitocin) IV

○Double rate of normal postpartum Oxytocin

●Misoprostol (Cytotec) PR

○Can cause slight increase in temperature

●Hemabate (Carboprost) IM

○Can lead to diarrhea

○Contraindicated in patients with asthma●

Methergine (methylgonovine maleate) IM

○Contraindicated in patients with hypertension

*bold is generic

Question 21

Q

Postpartum Infections: Delivery Risk factors

Answer

A

○Prolonged rupture of membranes >18 hours, internal monitors, chorioamnionitis, urinary catheterization, frequent vaginal exams, dystocia, operative delivery, cesarean delivery, traumatic delivery, PPH especially retained placenta

Question 22

Q

Postpartum Infections: Antepartum Risk Factors

Answer

A

○Poor nutrition, prior infection, chronic diseases, lack of prenatal care, lower socioeconomic status, obesity, smoking/drug abuse

Question 23

Q

Signs and Symptoms of Postpartum Infections:

Answer

A

fever, chills, tachycardia, foul-smelling or looking lochia or drainage, redness

*****If a fever spikes postpartum, we do not refer to it as chorioamnionitis anymore (only when pregnant) and instead endometritis

Question 24

Q

Postpartum Discharge Teaching: WHEN TO CALL PROVIDER

Answer

A

●Fever > 100.4, pain/redness in leg, abnormal discharge/odor, sudden increase in lochia, preeclampsia signs and symptoms (headache, vision changes, nausea/vomiting, epigastric pain)

Question 25

Q

Postpartum DVT: Signs and Symptoms of Thrombophlebitis: Inflammation

Answer

A

●Signs and symptoms: redness, warmth, pain, tenderness, edema, fever

●Interventions: elevate, heat, pain meds, SCDs

●Can progress to superficial thrombophlebitis, DVT, pulmonary embolism (PE)

Question 26

Q

Postpartum DVT: Signs and Symptoms of Thrombosis/DVT: clot formed from inflammation or partial obstruction of a vessel

Answer

A

●Similar signs & symptoms as above

●Similar treatment with addition of strict bedrest and initiation of anticoagulant

Question 27

Q

Ideal Newborn Vital Signs

Answer

A

●Allow a transition period for vitals to regulate

●Heart rate: 120-160○Brief fluctuations above or below normal depending on sleep/active states

●Temperature: 97.7-99.5 F (36.5-37.5 C)

●Respirations: 30-60

Question 28

Q

MILD signs of Respiratory Distress

Answer

A

●Nasal flaring

●Grunting

●Retractions (use of intercostal or subcostal muscles “drawing in” of tissue between ribs)

Question 29

Q

MODERATE/SEVERE Respiratory Distress

Answer

A

●Suprasternal or subclavicular retractions with stridor or gasping

●Seesaw or paradoxical respirations

●Circumoral cyanosis (bluish of lips/mucous membranes)

●Central cyanosis○Late sign of distress indicating hypoxemia

●Apnea > 30 seconds

Question 30

Q

First thing to do when you see Moderate/Severe Respiratory Distress?

Answer

A

ASSESS!!!

then…call for help.

Question 31

Q

Transient Tachypnea of the Newborn (TTN)

Answer

A

●Mild TTN occurs 1-2 hours post-birth●

Shows signs of respiratory distress

●May require supplemental oxygen

●Usually resolves within 24 hours

Question 32

Q

Heat Loss: Convection

Answer

A

●Convection: flow of heat from body surface to surrounding cooler air○Example: naked baby in bassinet losing heat to cool air around them rather than being swaddled with a hat

Question 33

Q

Heat Loss: Conduction

Answer

A

●Conduction: flow of heat from body surface to a cooler surface in direct contact○Example: naked baby lying on a cold scale to be weighed without a blanket on it

Question 34

Q

Heat Loss: Evaporation

Answer

A

●Evaporation: flow of heat when liquid is converted to a vapor○Most significant cause of heat loss in the days after birth○Example: moisture vaporization from the newborn skin before dried after a bath

Question 35

Q

Heat Loss: Radiation

Answer

A

●Radiation: flow of heat from body surface to a cooler solid surface nearby (not directly touching)○Example: baby’s bassinet next to a window in the winter months rather than baby being far from window and any air drafts

Question 36

Q

Because of heat loss by convection: The ambient temperature in newborn care ares should range between what temperature and what humidity?

Answer

A

ambient temperature in newborn care areas should range between 22° and 26° C (72° to 78° F)

the humidity between 30% and 60%

Question 37

Q

Cold Stress Facts

Answer

A

●Increased physiologic and metabolic demands caused by hypothermia

●Symptoms: hypothermia, pale, mottled, cold skin●Can lead to and exacerbate hypoglycemia, hyperbilirubinemia, respiratory distress

●Avoid by minimizing heat loss and maintaining in neutral thermal environment

Question 38

Q

GI and Renal System Facts:

Answer

A

●Newborns have diuresis of excess extracellular fluid the first few days after birth○Contributes to expected weight loss < 10% of body weight●

New research is emerging about the microbiome and health and relationship between birthing person and newborn’s microbiomes○Mode of birth affects microbial colonization of the newborn○Additional factors are antibiotic use, diet, and environment

Question 39

Q

Hepatic System Facts

Answer

A

●Immature at birth

●Liver functions: iron storage, glucose homeostasis, fatty acid metabolism, bilirubin synthesis, coagulation, drug metabolism

●Newborns have high concentrations of red blood cells (RBCs) at birth and these RBCs have shorter life spans → ↑ bilirubin which is a byproduct of RBC hemolysis → ↑ build-up of unconjugated bilirubin that must be broken down by liver

Question 40

Q

Jaundice:

Answer

A

●Jaundice: yellow discoloration of skin and sclera of eyes○Appears when total serum bilirubin > 6-7 mg/dL○Risk factors: Born <38 weeks, exclusive breastfeeding,prior baby with jaundice, significant bruising during delivery

Can be harder to assess visually in darker-skinned newborns

****Jaundice usually starts in the head and progresses downward to the rest of the body

Question 41

Q

Bilirubin:

Answer

A

●Bilirubin: waste byproduct produced by RBC hemolysis○Two types: conjugated (easily excreted from the body) and unconjugated (insoluble and must be conjugated in liver to be excreted)

Question 42

Q

Acute bilirubin encephalopathy is?

Answer

A

●bilirubin toxicity when bilirubin levels are high enough to cross the blood-brain barrier

○Signs and symptoms: lethargy, irritability, seizures, coma, death

Question 43

Q

Kernicterus: Definition and S/S

Answer

A

●irreversible long-term effects of bilirubin toxicity

○Signs and symptoms: hypotonia, hearing loss, delayed motor skills, cerebral palsy

Question 44

Q

Icteric:

Answer

A

adjective used to describe being affected by jaundice

Question 45

Q

●Physiologic jaundice

Answer

A

○Common (occurs in ~60% term, 80% preterm infants)○Due to high levels of unconjugated bilirubin○Presents after 24 hours of life○Usually self-resolves without treatment

Question 46

Q

Pathologic Jaundice

Answer

A

○Less common○Presents in the 1st 24 hours of life○Usually occurs due to a medical condition and/or severely high levels of bilirubin■Common cause is blood type incompatibility (ABO or Rh incompatibility)

*more severe type of jaundice

Question 47

Q

●Breastfeeding-associated jaundice (early-onset)

Answer

A

○Occurs at 2-5 days after birth○Hyperbilirubinemia occurs due to lack of effective breastfeeding (breastfeeding itself is not a cause)

Question 48

Q

●Breast milk jaundice (late-onset)

Answer

A

○Occurs at 5-10 days after birth○Rare, unknown cause but likely factors in breast milk decrease ability to excrete unconjugated bilirubin

Question 49

Q

Screening for Hyperbilirubinemia

Answer

A

●Part of newborn assessment to inspect for jaundice

●Transcutaneous bilirubinometry (TcB or TcBilli) is a monitor used on the forehead of every baby before hospital discharge○Screening tool only (not reliable if bilirubin > 15)

●If high, will obtain a total serum bilirubin level via heel stick for more accurate measurement

Question 50

Q

Jaundice Treatment

Answer

A

●Feeding → stooling → way to excrete unconjugated bilirubin○Physiological jaundice typically resolves with increased feeding

●Hyperbilirubinemia related to pathologic jaundice and/or very high levels, may require phototherapy○Light energy used to change shape of bilirubin causing unconjugated → conjugated for easier excretion → reduces circulating bilirubin

●Exchange transfusion: most invasive treatment if phototherapy is not sufficient or if encephalopathy/kernicterus occurs○Performed in NICU where infant's blood is replaced with donor blood

Question 51

Q

Phototherapy:

Answer

A

-Phototherapy does not use significant UV radiation. Opaque eye mask prevents retinal damage. Can increase heat loss via evaporation so important infant is still feeding q2-3 hours to prevent dehydration (only a diaper and eye protection) No lotion

-Many factors vary in phototherapy causing a unique experience for each individual baby based on their clinical findings

Goal of phototherapy: “bilirubin level should begin to decrease within 4 to 6 hours after phototherapy is initiated and within 24 hours should decrease by 30% to 40%”

Question 52

Q

Integumentary System in Baby

Answer

A

●So many NORMAL skin changes! Most self-resolve

●Vernix: prevents heat loss via evaporation; emollient, antimicrobial, and antioxidant properties; also decreases the skin pH, skin erythema, and improves skin hydration (in addition to possibly contributing to a healthy microbiome)- (white cheesy stuff)

●Lanugo:coarse body hair that will fall off

●Creases on the palms and soles of feet●

Milia:-small, whiteheads that look like baby acne

●Peeling (desquamation)

●Port wine stain (red birthmark-doesn’t resolve)

●Harlequin sign-a transient condition where half of the face appears red

●Mongolian spots- blue spots on back of rear end

●Stork bites (nevi)

●Erythema toxicum (newborn rash)

**The soles of the feet should be inspected for the number of creases during the first few hours after birth; as the skin dries, more creases appear. More creases on the palms of hands and soles of feet correlate with a greater maturity rating.

Question 53

Q

Crytorchidism

Answer

A

failure of testes to descend; more common in preemies)

Question 54

Q

Hypospadias vs Epispadias

Answer

A

urethra is below tip of penis)

vs

(urethra is above tip of penis)

Question 55

Q

Molding:

Answer

A

overlapping of cranial bones during birth to allow passage through the birth canal → variations in shape of head

Question 56

Q

Caput succedaneum:

Answer

A

● “caput” or “cone head” caused by sustained pressure during birth → compression of vessels → ↓ venous return → edema

Question 57

Q

Cephalohematoma:

Answer

A

●blood collection between skull bone and periosteum○Does not cross suture lines; firmer and more defined than caput○Resolves within 2-8 weeks; usually occurs with caput succedaneum

Question 58

Q

Subgleal hematoma

Answer

A

can also occur and is rare but more severe; often occurs from the shearing forces of an operative delivery

Question 59

Q

What increases the risk of developing a cephalohematoma?

What can having a cephalohematoma increase the risk of the newborn developing?

Answer

A

Forceps

Hyperbiliriumia

Question 60

Q

Differentiate between normal tremor, hypoglycemia jiggering, or seizure activity

Answer

A

○Tremors or jitteriness are easily elicited by motions or voice and cease with gentle restraint of the body part, whereas seizure activity continues.○Passive flexion and repositioning of the tremulous extremity reduces or stops the movement.○Seizure activity is unique in that it is associated with ocular changes (eyes deviating or staring) and autonomic changes (apnea, tachycardia, pupil changes, increased salivation) *test blood to see if jitteriness is from low blood sugar

Question 61

Q

1st 2 Hours of Life: L&D or Baby Nurse Care: Nursing Interventions

Answer

A

●Apgar scoring●Vital signs q30●Newborn assessment q30●I&Os●Thorough newborn assessment●Administration of erythromycin and vitamin K●Assistance with first feed●Security tags●Education

Question 62

Q

Apgar Score adaptation:

Answer

A

0-3 severe distress

4-6 moderate difficulty

7-10 adapting

Question 63

Q

Apgar Heart Rate Score: 0,1,2

Answer

A

0: absent

1: Slow< 100/min

2: > 100/min

Question 64

Q

Apgar Respiratory Score: 0,1,2

Answer

A

0: absent

1: Slow, weak cry

2: Good cry

Answer 65

A

0- flaccid

1- Some flexion of extremities

2- Well flexed

Answer 66

A

0-Blue, Pale

1- Body pink, extremities blue

2- Completely Pink

Answer 67

A

At term >37 weeks, average measurements:

●Weight: 2500g-4000g (5.5lbs-8.8lbs)○Described in further detail based on gestational age using a growth chart○

Appropriate for gestational age (AGA): Infants between 10-90th percentile○

Small for gestational age (SGA): Infants <10th percentile○

Large for gestational age (LGA): Infants >90th percentile

●Length: 45cm-55cm

●Head circumference: 32cm-38cm

Answer 68

A

●Some reflexes are vital for survival

●Rooting is a sign of hunger, sucking, sneezing, gagging

●Newborns are nasal breathers○~3 weeks a reflex develops causing mouth opening if nose obstructed

●Presence of reflexes reflects neurologic intactness and maturity

Answer 69

A

●Together with daily weights is a great indicator of feeding success

●In the first 3 days of life, the minimum # of expected wet and dirty diapers correlate with how many days old the baby is

●Meconium is first bowel movement and will transition over the next few days○Breast milk fed babies stools: black → green → yellow, seedy (sweet smell)○Formula fed babies stools: brown, thick (bad smell)

●Urine is usually straw colored and odorless○A sign of dehydration is pink-tinged uric acid crystals called “brick dust”

●Spitting up is common and normal. If excessive or appears painful, not normal

Answer 70

A

●Blood sample obtained via heel stick and sent to external lab○Results communicated with pediatric provider after discharge

●Must be performed after 24 hours for accuracy

●Required by the state

●Examples include phenylketonuria (PKU) and cystic fibrosis

Answer 71

A

●Optional medical procedure●Often performed by an OB/GYN●Performed after 24 hours of life●Requires “circ care” post-procedure○Involves gauze and vaseline○Monitor bleeding and healing○Continues 7-10 days post-procedure based on pediatric provider’s recommendations

Nursing Interventions:

●Assist with procedure in terms of comfort, gathering equipment, positioning baby, perform time out with doctor, circ care, education to family, assess I&Os

Answer 72

A

<ul><li>Use a fan on on for more circulation in the room and a pacifier when sleeping</li><li>sleep in parents room for at least 6 months to a year</li></ul>

<ul><li>Risk factors: parent/drug alcohol use, sleeping on stomach, formula fed, bed-sharers</li></ul>

Answer 73

A

<ul><li>no fat deposits,</li><li>difficulty maintaining temperature,</li><li>decreased immune activity,</li><li>immature organs (↑ risk for hyperbilirubinemia, ↓ kidney function,</li><li>hypoglycemia)</li><li>Respiratory distress due to absent or decreased surfactant, immature regulatory center, pliable thorax</li></ul>

Answer 74

A

●Acute inflammatory bowel disease●

●Bowel swells → breaks down → unable to produce its own natural defenses → ↑ risk bacterial colonization

●Risk factors: preterm infants, formula fed

●Early signs and symptoms nonspecific: fatigue, abdominal distension

●Bowel rest is indicated; when safe to resume feedings, breast milk is best

●Nursing interventions: avoid rectal temperatures, infection control

BABIES MAJOR AT RISK FOR INFECTION!!!

Answer 75

A

●Risk inversely proportional to gestational age

○Preemies have ↑ fragile cerebrovascular system, ↑ permeability of capillaries, prolonged PTT

●Hypoxic-ischemic brain injury

●Intraventricular or intracranial hemorrhage

○Ruptured vessel from ↑ cerebral blood flow to area

●Treatment: Therapeutic hypothermia appropriate for late preterm and term newborns○Body or head cooling within 6 hours after delivery improves outcomes ○Otherwise supportive measures

Answer 76

A

At 24 hours

Answer 77

A

●A leading cause of neonatal morbidity and mortality●Symptoms often discrete and nonspecific○Important to catch early

Types:

●Early-onset (congenital): within 1 week of birth (often within 72 hours)

○Rapid onset○Inversely related to infant birth weight○Group beta strep (GBS) sepsis most common

●Late onset: occurs later than 1 week after birth (usually 7-30 days postpartum)○Community or hospital-acquired infections○Pneumonia and bacterial meningitis are most common

Answer 78

A

●Early symptoms: lethargy, poor feeding, poor weight gain, irritability

●Later symptoms: temperature instability (typically hypothermia), diarrhea, vomiting, decreased reflexes, pallor, mottled skin, respiratory distress symptoms

Answer 79

A

Nursing interventions:

●Decrease stimuli, consolidate care, ensure nutrition/hydration, promote parent-infant attachment when appropriate (skin-to-skin) and breastfeeding, facilitate self-soothing, swaddle/rock

Answer 80

A

●Symptoms: tachycardia, fever, diarrhea, projectile vomiting, nasal congestion, hyperactivity, irritability, excessive crying, perspiration, feeding issues

Answer 81

A

●Fetal alcohol syndrome (FAS)○Physical and behavioral symptoms plus anatomical manifestations

■Abnormal facial features (small eyes, thin upper lip, indistinct philtrum)

■Seizures most common; also jitteriness, increased tone, hyperreflexia, irritability

●Alcohol-related neurodevelopmental disorder (ARND)

○Behavioral and cognitive disabilities

●Alcohol-related birth defects (ARBD)

○Congenital cardiac, musculoskeletal, renal, and/or auditory manifestations

Answer 82

A

●Most often occurs due to isoimmunization (usually Rh incompatibility)

○Less often associated with ABO incompatibility

●Most common reason for pathologic jaundice

Answer 83

A

Sinousiodal

Answer 84

A

●When the birthing person has a different blood type than the baby and antibodies cross the placenta causing hemolysis in the newborn

●Most commonly occurs when birthing person is O and baby is not

○Due to birthing person with O blood type having anti A and B antibodies that can cross placenta

●Wide variability in maternal sensitization to Rh + antigens → wide variability in symptoms/effects

Answer 85

A

Yes, but not as severe as symptoms

Answer 86

A

●“Single most predictive factor of fetal well-being in a baby born to a diabetic mother is their euglycemic status”

○Uncontrolled blood sugars in early pregnancy increase risk of cardiac and CNS anomalies

○Respiratory distress is a concern due to reduced surfactant synthesis related to maternal hyperglycemia

●Hallmark signs and symptoms: macrosomia or LGA (↑ risk for shoulder and labor dystocia)and hypoglycemia○Can occasionally manifest as growth restricted (IUGR) or SGA

Answer 87

A

Nursing interventions:

●Observe for signs and symptoms of hypoglycemia, cardiac conditions, and respiratory distress; monitor blood sugars per hypoglycemia protocol

Answer 88

A

● autosomal recessive enzyme deficiency unable to break down phenylalanine requiring strict dietary changes

Answer 89

A

●variety of causes; requires thyroid hormone replacement

Answer 90

A

autosomal recessive leading to 1 of 3 enzyme deficiencies requiring specific dietary changes

Answer 91

A

●Lung disease characterized by immature lung development●Almost exclusive to preterm infants; insufficient surfactant is main cause

Answer 92

A

Tachypnea, Dyspnea, retractions, crackles, grunting, flaring of nares, cyanosis or pallor, apnea

*with progressed condition deteriorating vital signs including BP, apnea, and body temperature instability

Answer 93

A

●After establishment of effective respirations, warmth for premature infants is next priority●Goal is a neutral thermal environment until able to control their own thermal stability○Incubator, radiant warming panel, open bassinet with cotton blankets, plastic wraps/bags

Answer 94

A

○Some babies ready as soon as 28 weeks○Suck/swallow coordination doesn’t occur until 32-34 weeks (not synchronized until 36-37 weeks)

Answer 95

A

●Therapeutic communication, anticipatory guidance for delivery, allow patient and family to lead but provide boundaries, give options

Answer 96

A

assess risk factors, educate on process, diagnoses, and after care; aid in decision making; arm precautions (avoid blood pressures, IVs on arm of mastectomy)

Answer 97

A

●Similar as other cancers (age, obesity, family or personal history, unhealthy lifestyles)●Earlier menarche or later menopause●Less or later pregnancies/breastfeeding●Dense breast tissue

Answer 98

A

●Perimenopause: length of time between the end of regular menstrual cycles until menopause

○Large variation among patients-average length is 4 years

○Transition phase with decrease in ovarian function and hormone production

○Decrease in estrogen → side effects

○Often characterized by irregular periods, vasomotor symptoms (hot flashes), vaginal dryness, insomnia

○Pregnancy can still occur!

Answer 99

A

●Menopause: the last menstrual period

○Cannot be confirmed until one year of no menses○Marked by a single event

Answer 100

A

●Postmenopause: begins one year after thelast menstrual period

○Longest phase

Answer 101

A

●Bacterial●Most common reported STI●Majority asymptomatic; post-coital spotting, dysuria, abnormal discharge ●PO antibiotics for patient and their partner is treatment●Pelvic inflammatory disease (PID) is most common complication●Nursing interventions: antibiotic education

Answer 102

A

●Bacterial●Often asymptomatic; yellow/green discharge, menstrual changes; rectal pain; diarrhea●Ceftriaxone IM is treatment●PID is a complication●Nursing interventions: encourage condoms or abstinence until fully treated to prevent reinfection; partners in last 30 days should be screened

Answer 103

A

●Bacterial●Types/symptoms:○Primary: Painless chancre (lesion)○Secondary: maculopapular rash, lymphadenopathy, condylomata lata ○Tertiary: multi-organ system failure, often preceded by a latent asymptomatic period ●Can progress to next stage and ultimately death if untreated○A Jarisch-Herxheimer reaction can occur (severe febrile reaction with headaches and myalgias within 24 hours of Penicillin treatment)●Penicillin G is treatment●Nursing interventions: Education-testing has high false positive and negative rates; monthly follow-up to ensure treatment is successful

Answer 104

A

●Incurable virus●HIV progresses to acquired immunodeficiency syndrome when there is depression of cellular immunity●At risk for opportunistic infections and worse disease course is co-infected with HPV●Flu-like response, sore throat, rash, weight loss●Triple drug antiviral or highly active antiretroviral (HAART) keeps viral load under control●Nursing interventions: informed consent, counseling before and after testing, ensure confidentiality, encourage more frequent STI screening

Answer 105

A

●Also known as condylomata acuminata or genital warts●Most common sexually-transmitted virus●Types: 100+ strains○Most low-risk strains cause genital lesions○High-risk strains increase risk for genital tract cancers, especially cervical cancer ●Painless lesions, dyspareunia (painful sex), abnormal discharge●HPV and lesions mostly self-resolve; if don’t, colposcopy and/or loop electrosurgical excision procedure (LEEP) remove precancerous cells●Nursing interventions: determine if candidate for HPV vaccine series, educate, ensure up to date with screening

Answer 106

A

●Type: Incurable virus●Types: HSV-1 (oral) and HSV-2 (anal) but can be transferred via other routes○Primary outbreak: painful and itchy lesions, flu-like symptoms, discharge○Secondary outbreaks: less severe, recurrent lesions●Antiretroviral for episodic or suppressive therapy●In pregnancy, daily preventative treatment in third trimester because outbreak at time of labor requires a cesarean●Nursing interventions: ensure pregnant patients with history start antiretroviral suppression therapy ~36 weeks, educate

Answer 107

A

●Protozoan●Most common STI and likely underreported●Often asymptomatic or yellow-green vaginal discharge, dysuria, dyspareunia, petechiae “strawberry spots” on cervix●Antibiotic as treatment●Nursing considerations: educate, reassure

Answer 108

A

●Most common vaginitis●Anaerobic bacteria replacing healthy lactobacilli, changing the vaginal pH●Symptoms include vaginal “fishy” odor, discharge, itching●Nurse must counsel on antibiotic use and lifestyle changes

Answer 109

A

●Risk factors: antibiotic use, high sugar diet, diabetes, pregnancy, immunosuppression●Symptoms include itching, white discharge, pain with urination or intercourseNurse must counsel on antifungal and alternative remedies as well as lifestyle changes

***These are NOT sexually transmitted but the change in pH of the vagina when it comes in contact with semen can increase the risk for these vaginal infections

Answer 110

A

●Physical barrier preventing semen from entering vagina●Only contraception option that protect against STIs!●Different types:○Male and female condoms○Diaphragm: dome-shaped device that covers cervix○Cervical cap: (Femcap) 3 sizes that acts as a physical barrier over the cervix○Contraceptive sponge: sponge with spermicide and water that fits over cervix; one size fits all●Efficacy: Condoms: typical use (15% failure); Diaphragm: 4-8% with perfect use and 13-17% with typical use plus spermicide (cervical cap less)●Rare side effect of all except condoms is toxic shock syndrome (sunburn-type rash, flu-like symptoms)

●Nursing interventions: condom education; most diaphragms require fit and proper placement ; all except condoms must be kept in place for 6 hours after intercourse so spermicide can work; education about proper use and storage

Answer 111

A

●Chemical barrier●Recommended for use with diaphragms and cervical caps but NOT condoms●Does not protect well against STIs and if used more than twice daily, has even been found to increase HIV transmission●Different types:○Spermicides: chemicals that reduce sperm motility; many different routes available ○Phexxi: contraceptive gel that alters the vaginal pH; applicator inserted like a tampon within 1 hour before sex; can be used with any other form of birth control to enhance efficacy (except vaginal ring)●Efficacy: spermicides have 15-29% failure rate; Phexxi 86-93% effective ●Nursing interventions: educate, especially about methods that can and can’t be mixed

Answer 112

A

●Suppresses menstrual hormones to prevent ovulation, thickens cervical mucus, and thins uterine lining●Different types: pill, patch, vaginal ring and many different formulations of the pill○Pill: taken daily, may have placebo “sugar” pills○Patch: new patch placed weekly for 3 weeks then 1 week without patch○Vaginal ring: ring inserted for 3 weeks then removed for 1 week●Efficacy: Typical use 91% efficacy (pills), <9% failure rate (patch & vaginal ring)●Side Effects depend on type of pill: depression, nutrient depletion, water retention, decreased libido●Interactions: should not be taken with anticonvulsants, TB drugs, and some HIV meds●Contraindications: history of blood clots, breast cancer, liver disorders, lactation, <6 weeks postpartum, smoking if older than 35 years of age, migraines with aura, surgery with prolonged immobilization, severe hypertension, and diabetes with vascular involvement●Nursing interventions: education, ACHES warning signs, recommend prenatal vitamins to anyone of childbearing age

Answer 113

A

Abdominal pain

Ches Pain

Headaches

Eye problems

Severe leg pain

Answer 114

A

●Inhibits ovulation by decreasing and thickening cervical mucus, thins endometrial lining, and alters fallopian tube●Different types: pills (“Minipill”), arm implant, shot, intrauterine device○Pill: even more sensitive than COCs and must be taken within the same 3 hours every day○Shot (DMPA): 1 injection every 3 months○Arm Implant (Nexplanon): thin, rod inserted into arm and lasts up to 3 years○IUD (Mirena, Skyla, others): T-shaped device inserted into the uterus and lasts 2-5+ years depending on type●6% failure rate for DMPA shot; for implant and IUD: perfect = typical use ~99% efficacy●Side Effects: Irregular bleeding/spotting; DMPA shot side effects include temporary bone density loss and long return to fertility●Good candidates: those who combined oral contraceptives are contraindicated for●Nursing interventions: reiterate that timing is key for pills, anticipatory guidance about spotting/side effects; administer shot, educate

Answer 115

A

●T-shaped attached to strings inserted into uterus through the cervix; hormonal IUDs work the same as progestin-only methods; non-hormonal IUDs work because copper acts as a spermicide and inflames the endometrium●Different types: non-hormonal (copper) and hormonal (progestin-only)●Perfect use = typical use (1.7% failure rate); effective for 2-10 years depending on type●Copper IUD can cause heavier and more painful periods the first year of use; increased risk of PID if infection present at time of insertion; rare risk of uterine perforation upon insertion●Nursing interventions: anticipatory guidance about insertion; educate on signs of infection; instruct on how to check strings to confirm placement

Answer 116

A

●Arm implants●Intrauterine devices●Perfect use = typical use because no room for “user error” ~99%

Signs of complications of intrauterine devices:

Period late: abnormal spotting

Abdominal pain; pain with intercourse

Infection exposure; abdominal dischage

Not feeling well, Fever or chills

String missing, shorter or longer

Answer 117

A

●Surgical occlusion of ova (fallopian tubes) and sperm pathways● (vas deferens) or removal of female organs (uterus and/or ovaries)●Different types: male (vasectomy) outpatient procedure or female (tubal ligation procedure)●Perfect use = typical use; failure rate < 57/1,000 for female●Reversal possible for occlusion of pathways but not always successful ●Nursing interventions: client education, ensure male patients follow-up for repeat semen analysis after 3 months; ensure 30 day mandated wait period before signing paperwork and sterilization occurs

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