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Self-paced module 1 Flashcards

1
Q

What is the leading cause of neonatal sepsis?

A

GBS

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2
Q

What organism causes GBS? Where does this organism live?

A

Gram positive beta hemolytic cocci
Lives in a reservoir like GI tract or GU tract

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3
Q

How is GBS colonized? What s/s can be associated with colonization?

A

Chronic, intermittent, transient

Colonization in women in generally asymptomatic but can cause maternal UTI, infection in endometrium after birth, or intraamniotic infections
Preterm labor and stillbirth as also associated w/ GBS colonization

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4
Q

How is GBS transmitted to newborns?

A

Vertically - direct exposure during birth or ascending form vagina

Horizontally - cross contamination like poor hand hygiene

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5
Q

What is the transmission rate (likelihood of giving it to baby) influenced by?

A

How heavily colonized the women is
Site of colonization
Chronic colonization
Risk factors: preterm status, prolonged rupture of membranes, low birth weight and prescence of intraamniotic infection

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6
Q

What are the CDC guidelines for universal screening? What is the purpose?

A

All pregnant women should be cultured between 36-37 weeks w/ vaginal rectal culture

Very accurate at predicting GBS status if birth occurs within 5 weeks of obtaining the culture (if negative at 36-37 weeks, then it will remain negative until 41 weeks)

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7
Q

What are the exemptions to universal screening?

A

GBS bacteria of any amount found in clean catch urine sample
History of infant with invasive GBS sepsis

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8
Q

If GBS bacteria of any amount found in clean catch urine sample what is the treatment?

A

Treat UTI at diagnosis
Women will be given antibiotics in labor to prevent transmission to newborn

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9
Q

If mom. has history of infant with invasive GBS sepsis what is the treatment?

A

Prophylactic antibiotics in labor d/t history

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10
Q

How is a vaginal culture preformed? Can the patient do it themselves? What is not recommended?

A

Swab inserted into outer third of vagina and swiped down into the perineum and inserted into the rectum just past anal sphincter

Not recommended to do a cervical culture

With good education, patient can do culture themselves

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11
Q

GBS is generally treated with PNC, what testing should be done r/t this?

A

Susceptibility testing for patients with PCN allergies

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12
Q

Who should be treated with intrapartum prophylactic antibiotics?

A

Any positive GBS vaginal-rectal culture in the current pregnancy OR
History of:
1. GBS bacteria at any time in the pregnancy
2. Infant affected by invasive neonatal GBS infection
3. Universal screening cultures are not done because of the high risk of transmission `

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13
Q

What if mom hasn’t had the universal screening or you don’t have results?

A

Antibiotics should be given for these factors:

  1. Gestation less than 37 weeks
  2. Preterm pre-labor rupture of membranes (PPROM)
  3. Ruptured membrane more than 18 hours
  4. Intrapartum temp over 100.4
  5. History of GBS colonization in previous pregnancy d/t 50% that mom is colonized with GBS again
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14
Q

What is the reasoning behind giving prophylactic treatment? When should treatment be started?

A

Prevention of early onset neonatal sepsis
This is not the same as giving newborn antibiotics for a GBS infection

On admission and continued until the baby is delivered

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15
Q

What are the differences for a schedule C-section? What if they have a positive GBS result?

A

Universal screening at 36-37 6/7 weeks
Positive GBS:
1. Not in labor and membranes in tract – no treatment
2. In labor or membranes ruptured - treat w/ antibiotics prior to delivery

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16
Q

What is the recommended treatment for GBS? Why? Initial dose? Maintenance dose?

A

Penicillin G

New spectrum agent, targets gram positive, and less likely to cause antibiotic resistance to other vaginal organisms

Initial dose: 5 million units IVPB

Then 3 million units IVPB every 4 hours until delivery

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17
Q

What is the acceptable alternative if PNC G is not an option? Initial dose? Maintenance dose?

A

Ampicillin

2 g IVPB load

Then 1 g every 4 hours until delivery

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18
Q

What is considered adequate treatment?

A

Highest effectiveness is obtained with there is at least 4 hours between initial antibiotics and birth of baby

Can be effective after 2 hours

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19
Q

How do antibiotics work against GBS?

A

agents work by temporarily decreasing maternal vaginal GBS colony count, preventing fetal or newborn surface and membrane colonization and reaching levels in newborns blood stream to effectively kill B streptococcus

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20
Q

If patient states they have a PNC allergy what should you do?

A

Ask them what occurred during the time they took it to determine the type of reaction - high or low risk
Consider using a PNC allergy skin test

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21
Q

What is a high risk for anaphylaxis reaction to PNC? (9)

A

History of anaphylaxis
Angioedema
Respiratory distress
Urticaria after being given penicillin or cepalosporin
Recurrent reactions
Reactions to multiple beta-lactam antibiotics
Positive skin testing
Rare delayed reactions
SJS

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22
Q

What is a low risk for anaphylaxis reaction to PNC? (4)

A

Non-urticarial maculopapular rash without systemic symptoms
Family history of penicillin allergy but no personal history
Non-specific symptoms such as nausea, diarrhea, and yeast vaginitis
Patient reports a history but cannot recall the symptoms or treatments

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23
Q

If a patient is low risk for anaphylaxis, what alternative antibiotics can be given? Doses?

A

Cephazolin

2 g IVPB load, then 1 g IVPB every 8 hours until delivery

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24
Q

If a patient has a high risk for anaphylaxis and identified sensitivity of GBS isolate what alternative antibiotic can be given? Dose?

A

Clindamycin

900 mg IV then every 8 hours until delivery

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25
If a patient has a high risk for anaphylaxis and GBS not sensitive to clindamycin what alternative antibiotic can be given? Dose? Considerations?
Vancomycin 20mg/kg every 8 hours Max single dogs 2 g Infuse over a minimum of 1 hours or 500mg/30 minutes a dose for a dose over 1 g
26
What is specific about treating GBS with clindamycin?
Need to do a culture and sensitivity of vaginal-rectal culture when there is a PNC allergy to determine which antibiotic to use instead to ensure it is effective against GBS
27
Why is screening and treating GBS so important?
Mortality: less than 10% of neonate affected by GBS sepsis Morbidity: long term neuro complications are common
28
What is early onset neonatal sepsis? What are the s/s?
Occurs in first 7 days of life Temperature instability, hypothermia, poor feeding, lethargy, respiratory distress, pneumonia, apnea, and shock
29
What is late onset neonatal sepsis? What are the s/s?
7 days – 3 months Often results in meningitis
30
What are nursing considerations r/t GBS on admission of a patient in labor?
Review record on admission for GBS status Prophylactic treatment if indicated Communicate Care of the neonate
31
When reviewing the record for GBS status what should you look for?
Include vaginal rectal culture results History of GBS urinary infection at any time during pregnancy Past history of delivering newborn who developed GBS sepsis
32
When caring for neonate what should you do r/t GBS?
Determine estimated risk of developing early onset sepsis using a neonatal sepsis calculator Monitor s/s for neonatal infection and lab testing Administer antibiotics if indicated – symptomatic
33
What puts an infant at increased risk of contracting GBS?
Neonate is at increased risk of developing GBS sepsis if treatment is inadequate (not enough time has gone by since being given antibiotics)
34
How is chlamydia transmitted? Causative agent?
Acending through sexual contact Transmitted to fetus via birth cancel Bacterium - chlamydia trachomatis
35
What are the s.s of chlamydia?
Asymptomatic Abnormal vaginal discharge & painful urination (dysuria)
36
What are occurs if chlamydia goes untreated? Fetal effects? Neonatal effects?
If untreated: Lead to pelvic inflammatory disease, Infertility, and Increased risk of ectopic pregnancy Fetal Effects: Risk of preterm labor and PROM Neonatal effects: Ophthalmic neonatorum and Chlamydial pneumonia
37
How is ophthalmic neonatorum prevented?
E-mycin opthalmic ointment
38
What is the treatment for chlamydia?
Azithromycin Partner co-treatment w/ azithromycin or doxycycline Repeat test of cure 1-3 mths after treatment completion Abstain from sex for 2 weeks
39
How is gonorrhea transmitted? Causative agent?
Sexually transmitted Through contact with birth canal Bacteria - neisseria gonorrheae
40
What are the s/s of gonorrhea?
Asymptomatic usually Thin adherent discharge
41
What are the effects of gonorrhea on newborn?
Ophthalmia neonatorum Sepsis Joint infection
42
What is the treatment for gonorrhea?
Abstinence Usually Ceftriaxone IM injection Treat all partners Test of cure 1-3 mths after treatment completion Prevention: Safer sex and E-mycin ophthalmic ointment
43
How is HSV transmitted? Causative agent?
Direct contact with lesion during birth after membranes rupture Sexual contact Transplacental - rare Viral HSV! or HSV2
44
What are the s/s of HSV?
Vaginal fullness, tingling, itching, burning or swelling Blisters, ulcers, scabs
45
What is the neonatal risk with HSV?
50-60% mortality w/ exposure to primary lesion/infection Neurological complications & sepsis
46
What is the treatment for HSV?
Zovirax (Acyclovir) 400 mg BID Valacyclovir 500 mg BID orr 1000 mg daily Prophylactic antiviral meds 35 -36 wks Antivirals if 2-3 outbreaks during pregnancy
47
HSV vaginally delivery or C-section? Will this affect mom forever?
Vaginal delivery no active lesions for 7 days C-section if active lesions Lifetime infection w/ individual variation on incidence & severity of lesions
48
With HSV is the baby more likely to contract after first outbreak or recurrent outbreaks?
50% chance first will contract if moms first outbreak because first outbreak is more severe 1-5% if recurrent outbreak
49
How is HPV transmitted? Causative agent?
Sexually Transplacentally?? Viral
50
What are the s/s of HPV? High risk/low risk?
Wart on vagina that are painless and flat High risk --> cervical cancer Low risk --> condyloma (warts)
51
What is the neonatal risk with HPV?
Juvenile laryngeal papillomatosis More a risk w/ initial outbreak HPV & direct contact
52
What is the treatment for HPV?
TCA (Trichloroacetic acid), laser, or surgery Often resolve without treatment Prevention: HPV vaccine
53
C-section or vaginal delivery with HPV?
Delivery: C-section not warranted May impede vaginal delivery if warts are very large & obstruct vaginal canal
54
How is syphilis transmitted? Causative agent?
Sexually Transplacentally Viral - treponema palidum
55
What are the s/s of syphilis? What testing should be done?
Painless canker at site of transmission Serologic testing recommended on all pregnant women
56
What are the fetal-neonatal effects of syphilis?
2nd trimester loss Stillbirth at term Congenital infection Live unaffected infant
57
What is the treatment for syphilis?
PNC G Screening and treat all partners Immediately treat because critical to mom and baby
58
How is trichomoniasis transmitted? Causative agent?
Sexually Protozoan: trichomonas vaginalis
59
What are the s/s of trichomoniasis?
Asymptomatic Malodorous yellow-green discharge Vulvar irritation (strawberry patches on cervix) Preterm labor, birth, or PROM, SGA
60
What is the treatment of trichomoniasis? What can the treatment cause?
Metronidazole (Flagyl) Treatment can lead to preterm labor
61
What is bacterial vaginosis? What is it caused by?
Bacterial imbalance in the vaginal canal Can be caused by douching, detergents, hot tubs Gardnarella vaginalis
62
What are the s/s of BV? What could it cause for the fetus?
Asymptomatic Fishy odor & discharge Preterm labor/birth PROM Chorioamnionitis (infection)
63
What is the treatment for BV?
Metronidazole (Flagyl) Prevention measures
64
How is toxoplasmosis transmitted? What is it caused from?
Transplacentally Eating raw or undercooked meat/game meats Contact w/ feces of infected cats In the soil (gardening) Protozoan: Toxoplasma gondii
65
What are the s/s of toxoplasmosis? When is mom at highest risk?
Mild flu like s/s Highest risk in 3rd trimester
66
What is the fetal risk with toxoplasmosis?
Severe neonatal disorders (blindness, development delays, seizures) Severe fetal disease/death Hydrocephalus, microcephaly
67
What is the treatment for toxoplasmosis?
Recent infection: Spiramycin (↓ transmission to fetus but does not cross placenta to treat fetus) Suspected fetal infection: Sulfadiazine, Pyrimethamine & Folinic Acid (after 1 trimester) Prevent: don't eat raw meat or touch with bare hands, avoid infected cats, wash hands
68
How is varicella transmitted? What is the causative agent?
Airborne Direct contact Saliva Touching contaminated surfaces Transplacentally Viral
69
What are the s/s of varicella?
Small red spots that turn into scabs, blisters, ulcers Fatigue, fever loss of appetite
70
What is the fetal risk with varicella? Maternal? Neonatal?
Maternal: High risk of death to pneumonia Fetal: Lead to congenital varicella syndrom, Hypoplasia and contractures of limb, eye & CNS involvement Neonatal: highest risk if maternal infection is within 5 days before and less than 2 days after delivery
71
What is the treatment of varicella?
Treatment of active maternal infection: Acyclovir, Valcyclovir or Famcyclovir (reduce symptoms, duration, & intensity) Prevention: Vaccination
72
Should mom vaccinate while pregnant? Do antibodies from mom go to baby?
Maternal antibodies do not cross placental barrier If not immune, pt should vaccinate postpartum (live attenuated vaccine, should avoid pregnancy for 30 days after receiving)
73
How is parvovirus transmitted? Causative agent?
Transplacentally 1/3 of time Human B19
74
What are the s/s of parvo?
Slapped cheek appearance Low grade fever Nasal discharge HA Joint pain
75
What is the fetal risk with parvo?
Fetal death 10% (4-12 weeks after infection) but normal development if fetus survives Non-immune hydrops & marked fetal anemia (may need intrauterine transplant)
76
What is the treatment of parvo? Does the fetus need to be monied?
Avoidance of exposure Fetal surveillance w/ US evaluation of peak systolic velocity of middle cerebral artery
77
How is listeria transmitted? Causative agent?
Transplcentally Bacterium: Listeria Monocytogenes
78
What are the s/s of listeria?
Fever Muscle aches HA Stiff neck Confusion Loss of balance Chills
79
What are the fetal-neonatal effects of listeria?
Miscarriage; fetal death Neonatal death related to pyogenic meningitis
80
How is listeria treated?
Avoid eating high risk foods such as soft cheeses, deli meats, hot dogs, milk products, smoked seafood, sprouts, raw meat
81
How is coxsackie transmitted? Causative agent?
Bodily fluids Viral Infection (Hands, Foot, & Mouth)
82
What are the s/s of coxsackie?
Blister like rash the develops on hands, feet, and mouth Fever Poor appetite Runny nose Sore throat
83
What are the letal-neonatal effects of coxsackie?
Death Chorioamnionitis Placental infection Myocarditis, encephalitis
84
How is rubella transmitted? Causative agent? Diagnosis?
Transplacentally Viral infection
85
What are the effect of rubella on newborn?
Congenital heart congenital defects (PDA) Congenital cataracts Developmental delays Cerebral palsy Sensorineural deafnes
86
What is the treatment for rubella?
MMR vaccine Vaccination of all children & non-immune individuals Childbearing women: vaccination prior to pregnancy or in postpartum period
87
How long does rubella spread for? What should you do?
Can shed for 12 months Isolate infants with rubella
88
How is hep B transmitted? Causative agent?
Blood exposure Increased risk during delivery Viral
89
What is the treated of hepB?
Bathe ASAP Hepatitis B vaccine Hepatitis B immune globulin Other family members should be screened and treated Neonatal: HBIG and Hepatitis B vaccin
90
How do you diagnose HepB?
Hep B surface antigen part of initial OB labs Hep e antigen positive = diagnosis of active infection
91
How is HepC transmitted? Causative agent?
Blood exposure Increased risk during delivery Viral
92
Treatment of HepC?
Treatment controversial during pregnancy All pregnant should be screened w/ each pregnancy for HCV antibodies at 1st prenatal visit in settings where HCV prevalence is >0.1% Exposure usually w/ deliver
93
How is HIV transmitted? Causative agent?
Blood products Sexually Breast feeding Transplcentally Viral: Human Immuno- deficiency Virus
94
What are the s/s of HIV? Risk to child?
Flu like s/s Usually asmyp until progresses to AIDS Child may live to 10 years old with HIV
95
How do you test for HIV?
Two methods of rapid testing blood or saliva: OraQuick rapid HIV antibody test
96
How do you treat HIV in pregnancy? Labor? Neonatal?
Pregnancy: AZT (ZVD) Labor: IV Zidovudine Neonatal: Highly active antiretroviral therapy and c-section/intact membranes decreases transmission
97
What should you monitor mom for? What education should be given regarding HIV?
Monitor CD4 count Encourage safer sex: mother can be REINFECTED & cause new viral load
98
What should the neonatal care look like with HIV?
Wipe off secretions Bathe ASAP Use strict infection control techniques Breastfeeding contraindicated Neonatal med treatment Observe other infections in mother
99
How is TB transmitted? Causative agent?
Droplets in air Bacterium: Mycobacterium tuberculosis
100
How do you treat active TB? Inactive TB?
Active TB: Isoniazide, rifampin, ethambutol Inactive: - May delay treatment until postpartum Recommend TB skin or serum testing in high risk population
101
Can you breastfeed with TB?
Inactive TB: may breastfeed & delay treatment until postpartum Active: no direct contact w/ newborn until non-infectious
102
How is Zika transmitted? Causative agent?
Through Aedes species of mosquito Can be sexually contact up to 6 months after exposure Transplacentally Virus
103
What are the maternal s/s of Zika virus?
Fever, rash, headache, arthralgias/myalgias, red eyes
104
What are the fetal risks? What is congenital Zika syndrome?
10% risk with infected mother Miscarriage, stillbirth, growth restriction Congenital Zika Syndrome: microcephaly, ↓ brain tissue, ocular damage, limb/ joint defects hypertonia
105
What is the treatment/prevention for Zika virus? Testing?
Avoid traveling to high risk areas (carribean, Latin America, India, Central America) Testing: serum or urine testing
106
fHow is COVID transmitted? Causative agent?
Droplets Contact Viral
107
What are s/s of COVID?
fever, chills, loss of taste/smell, cough
108
What is the treatment for covid?
Vaccinate prior to and during pregnancy Daily low dose aspirin for all pregnanct patients with covid d/t hyper coagulability Could need to be hospitalized and ventilated Monoclonal antibodies recommended for patients w/ mild to moderate s/s and one or more risk factors (obese, CKD, DM, CVD)
109
How does CMV transmit?
Across placenta Cervical route during birth Close contact with infected individual
110
s/s of CMV?
asymptomatic
111
What are the CMV fetal-neonatal effects?
Fetal death SGA Microcephaly/hydrocephaly Cerebral palsy Developmental delays No damage
112
Treatment of CMV? Diagnose?
no treatment sero-conversion Amniocentesis
113
Where is transmission high? How long does viral shedding occur?
Viral shedding over many years Most high in day care

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