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Test 5 Flashcards

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1
Q

What is the difference between a hypotonic and a hypertonic labor pattern

A

Hypertonic=stronger contraction

Hypotonic weaker contraction

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2
Q

What are 2 interventions used to treat shoulder dystocia?

A

stop Oxytocin and turn to left side

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3
Q

What does tachysystole mean?

A

Contractions greater than 5 in a span of 10 minutes over 30 minutes

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4
Q

What are the 4 hallmarks of precipitous labor?

A
  • Giving a labor in less than 3 hours
  • Descent greater than 5cm/ hour (nulliparous)
  • Descent greater that 10cm/ hour (multiparous)
  • Hypertonic uterine contractions
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5
Q

What position should the mother be in if she has an umbilical cord prolapse?

A

McRobert’s position

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6
Q

What does the acronym HELPERR mean?

A
  • call for Help
  • Evaluate for Episiotomy (cut perineum)
  • Legs: McRoberts Maneuver
  • external Pressure: suprapubic
  • Enter: rotational maneuvers
  • Remove the posterior arm
  • Roll the patient to her hands and knees
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7
Q

What are 6 interventions for cleft palate repair?

A

• Soft elbow immobilizers for at least two weeks postop
• Avoid prolonged crying to avoid suture line problems
• Antibiotics may be prescribed
-use longer nipples prior to closure
place baby supine post-op when baby is sleeping
will need stimulation to provide a distraction

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8
Q

What are the three hallmark signs of tracheoesophageal fistula? (3C)

A

cyanosis, choking, coughing

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9
Q

What are the 6 signs and symptoms of tracheoesophageal fistula?

A
  • Excessive drooling and secretions
  • Frothing and bubbling at mouth and nose
  • Cyanosis
  • Respiratory distress
  • Choking with attempted feeding
  • When feeding, symptoms may intensify and lead to regurgitation, choking and aspiration
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10
Q

What are the 5 interventions for postop care for tracheoesophageal fistula?

A

o Have suction available
o Use slow intermittent suctioning to remove secretions
o Withhold oral fluids and maintain with IV fluids
o Feedings introduced slowly and in small amounts
o Teach parents how to take care of gastrostomy tube

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11
Q

What are the 7 s/s of GERD?

A
  • Vomiting and regurgitation that is non-bilious and includes undigested formula or food (most common)
  • Irritable and fussy
  • Dysphagia (difficulty swallowing) or refusal to feed
  • Choking
  • Chronic cough
  • Wheezing frequent respiratory infections
  • Apnea
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12
Q

What are the 6 postop interventions for GERD?

A
  • Thicken food -smaller feeding volume and increase frequency
  • Positioning to upright position
  • Assess growth of child
  • AVOID prone position; Ideal is right side-lying position
  • Assess respirations
  • PPI (Prevacid or Prilosec)/ Histamine h2 antagonists (Zantac and Pepcid)
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13
Q

What are the 4 postop interventions for GERD?

A
  • Do not burp
  • Avoid dietary irritants
  • Avoid vigorous playing after feeding
  • Encourage infant to be in an upright position for 20-30 minutes following feeding
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14
Q

What are the three types of dehydration?

A

• Isotonic dehydration (isonatremic)
• Hypotonic dehydration (hyponatremic) pulls Na out of the interstitial and extracellular cell
• Hypertonic dehydration (hypernatremic) no gradient to change
***in the blood

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15
Q

How is rotavirus transmitted?

A

Feco-oral

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16
Q

What are the 3 signs and symptoms of rotavirus?

A

diarrhea
vomiting
fever

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17
Q

What are the treatment options for rotavirus (2)?

A

hand wash and fluids

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18
Q

What is the vaccine schedule for rotavirus and the name of the vaccine?

A

o Roteq: 3 doses 2 months, 4 months, 6 months

o Rotarix: 2 doses 2 months, 4 months

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19
Q

Why don’t you give antimotility drugs to someone with gastroenteritis?

A

retain bacteria (have diarrhea to excrete bacteria)

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20
Q

What is pyloric stenosis?

A

INflammation between the opening of the stomach and small intestines causing an obstruction

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21
Q

What are 7 s/s of pyloric stenosis?

A 
•	Projectile vomiting/ emesis 
•	Irritable
•	Appears hungry
•	Fails to gain weight
•	Dehydration
•	Metabolic alkalosis may be present (At risk for hypochloremia, hypokalemia, and metabolic alkalosis (normal values are most common) )
•	Mass may be present in the RUQ
-> losing stomach acid
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22
Q

In constipation, what medication can be used?

A

miraLAX (polyethylene glycol)

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23
Q

What are 4 interventions for constipation?

A
  • Place child on toilet 20 minutes after eating
  • Offer high fiber food cut-up such as apples
  • Herbal stimulant laxatives discouraged for children younger than 12 years old
  • Avoid dependence on stool softeners and laxatives
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24
Q

What is Congenital Diaphragmatic (inguinal) Hernia?

A

It is when the bowel protrudes through the diaphragm into the thoracic cavity taking up space from the lung

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25
Q

What are the 2 s/s of inguinal hernia?

A

• Severity respiratory distress and pulmonary hypoplasia (lungs do not fully develop)

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26
Q

What are 3 nursing interventions for an umbilical hernia?

A

• Instruct parents to NOT apply tape, straps, or coins to reduce the hernia
• Educate parents to watch out for bleeding and recognize signs of infection
-Surgery is need in case of strangulation (closure of the muscular ring preventing intestines to go back into the abdomen)

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27
Q

What cannot people with celiac disease absorb?

A

vitamin ADEK, fat

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28
Q

What types of food should be recommended to a patient with celiac disease?

A
  • Gluten free diet (no wheat, barley, rye, and oats)

* Corn, millet and rice are acceptable

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29
Q

What are the 5 s/s of crohns disease?

A 
•	Abdominal pain
•	Diarrhea
•	N/V 
-weight loss
•	Test for anemia
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30
Q

What are the 3 interventions for crohns disease?

A
  • Aminosalicylates (Asacol) - nsaid
  • Corticosteroids (decrease inflammation)
  • Bowel rest and provide TPN
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31
Q

What is the recommended diet for crohn’s and ulcerative colitis disease?

A

• High carb, High protein, low fiber, normal fat

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32
Q

What is Hirschsprung Disease?

A

• Missing nerve cells in the colon causing difficulty to pass stools

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33
Q

What is the 4 s/s of Hirschsprung disease?

A
  • Failure to pass meconium with the first 48 hours
  • Failure to thrive
  • Poor feeding
  • Chronic constipation, vomiting and abdominal pain
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34
Q

What is intussusception?

A

Intestines goes inside itself

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35
Q

What are the 5 s/s of intussusception?

A
  • sudden pain
  • Pain relieved when the abdomen is relaxed
  • Fever, dehydration, abdominal distention, tender palpation, lethargy, grunting, possible vomiting
  • red jelly-like stool
  • dance sign (mass in RUQ)
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36
Q

What is McBurney’s point?

A

pain felt when palpating RLQ used to diagnose appendicitis

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37
Q

What is obturator sign?

A

pain felt when turning hips used to diagnose appendicitis

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38
Q

What is rebound tenderness for appendicitis?

A

Pain felt when pressure is let go on RLQ

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39
Q

What is Psoa’s sign and what does it indicate?

A

• Positive Psoas sign (lay on left side while right thigh is flexed backwards) the pain indicates swollen appendix

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40
Q

What is Ravsing sign?

A

when palpating LLQ, pain is felt on RLQ for appendicitis

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41
Q

What are the 4 interventions for appendicitis?

A
  • Position semifowler or right side-lying position
  • DO NOT APPLY HEAT
  • Antibiotics
  • Prepare for surgery
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42
Q

What are the 2 s/s of appendicitis

A

absent bowel sounds, abdominal distention

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43
Q

What is peritonitis?

A

Bacterial infection after the rupture of an abdominal organ

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44
Q

What are the 10 s/s of peritonitis?

A
  • Acute pain over abdomen (pain worsens when touched or moved)
  • Rigid abdomen (board-like)
  • Abdominal distention
  • Fever/ chills
  • Tachycardia
  • Hypothermia (late sign)
  • Decreased bowel sounds
  • Confusion
  • Decreased in urinary output
  • N/V
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45
Q

What does communicable disease mean?

A

An infection often caused by a direct transmission (from one person or animal to another by body fluid contact), an indirect transmission (person coming in contact with a contaminated object) or by vectors (ticks, insects)

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46
Q

What are the three factors of a communicable disease?

A
  • Infectious agent or pathogen
  • An effective means of transmission
  • Presence of a susceptible host
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47
Q

What are 5 live (attenuated) vaccine names?

A 
o	Chickenpox
o	MMR
o	Rotavirus
o	Smallpox
o	Yellow fever
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48
Q

What are 3 inactivated vaccines?

A

o Hep A
o Flu
o Polio (shot)

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49
Q

What is a recombinant/ conjugated vaccine and name three?

A

o Uses certain part of the gene such as the protein
o HPV
o Pertussis
o Pneumococcal/ meningococcus

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50
Q

What is a toxoid vaccine and name 2?

A

-uses toxins to build anitbodies
o Diphtheria
o Tetanus

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51
Q

Name 5 types of rash descriptions?

A
  • Vesicles- small fluid like sac
  • Papule- circular elevated to skin
  • Macule- flat lesion
  • Pustule- purulent filled sac
  • Petechiae – pinpoint red spots
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52
Q

What is the mode of transmission for conjunctivitis?

A

contact with secretions hand to eye (highly infectious, need to be treated)

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53
Q

What are the 5 s/s of conjunctivitis?

A
  • Edema of eyelid/ eye conjunctiva
  • Enlarged lymph nodes
  • Mucopurulent exudate
  • Itching, burning, photophobia
  • No change in vision
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54
Q

How do you diagnose conjunctivitis?

A

gram stain if it is from herpes or chlamydia

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55
Q

What is the treatment for conjunctivitis?

A
  • Antibiotics administered to the eyes
  • Cannot go back to school until taken antibiotics for 24 hours
  • Hand hygiene and avoid sharing towels
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56
Q

What is Giardia?

A

• Cysts are ingested and passed into the duodenum and proximal jejunum where they begin actively feeding; excreted in the stool

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57
Q

What are the 4 modes of transmission for giardia?

A

person to person contact, unfiltered water, improperly prepared food, contact with animals

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58
Q

What are the 3 s/s for giardia in infants?

A

diarrhea, vomiting, anorexia, FTT (failure to thrive)

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59
Q

What are the 2 s/s in older children who have giardia?

A

abdominal cramps, and intermittent loose, foul smelling, watery, greasy stool

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60
Q

How long do the s/s last for giardia and how do you diagnose it?

A
  • Symptoms lasts 2-6 weeks

* Stool specimen obtained on three separate days

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61
Q

What are the 4 treatments for giardia?

A
  • Metronidazole (Flagyl)
  • IV hydration
  • Correction of electrolytes
  • Use gloves
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62
Q

When can the child go back to school if they have giardia?

A

Once the diarrhea goes away

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63
Q

what are pinworms?

A
  • Eggs hatch in upper intestine and mature over 1-2 months. Larvae then migrate to the colon and lay eggs. Movement of the worms causes INTENSE PRURITIS
  • When you scratch, it deposits eggs onto the hands and underneath the nails
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64
Q

What 2 s/s would you see if the patient has pinworms?

A

intense pruritis at night and irritability/ restlessness

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65
Q

What 3 diagnoses would be used to test for pinworm?

A
  • Look for worms 2-3 hours after child is asleep
  • 3 part tape test
  • Examine fingernails often child under a microscope for eggs
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66
Q

what are 4 things you can educate the patient on when they have pinworms?

A
  • Hand hygiene after bathroom and before eating
  • Wash all raw fruits and vegetables
  • Dogs/ cats (clean them and litterbox)
  • Wash after swimming
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67
Q

what are 2 treatment options needed for someone with pinworm?

A
  • Albendazole, mebendazole (repeat after 2 weeks)

* Whole family has to be treated

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68
Q

What are scabies?

A

mites that tunnel under skin

*contact precaution

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69
Q

What are 2 s/s of scabies?

A

• Intense pruritis with scabbing linear patterns

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70
Q

What are 3 treatments for scabies?

A
  • Permethrin 5% cream, Lindane cream (Done after skin is cleansed and placed entire body), then repeated one week later
  • All family members must be treated
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71
Q

What is Pediculosis Capitis?

A

Lice, Child is excused if they have lice; not excused by the eggs

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72
Q

What are the 2 treatments for Pediculosis Capitis?

A

NIX, permethrin 1%

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73
Q

What is acetaminophen?

A
  • Acetaminophen is an analgesic, antipyretic agent; metabolized in liver
  • Hepatotoxicity: greater than 200
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74
Q

What are the 5 s/s of acetaminophen poisoning?

A
  • N/V
  • Diaphoresis
  • Pallor
  • RUQ pain
  • Jaundice
  • Confusion/ stupor
  • Coagulation abnormalities
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75
Q

What is the antidote for acetaminophen poisoning?

A

acetylcysteine (MUCOMYST)

-activated charcoal can be used as well

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76
Q

What is aspirin?

A
  • Analgesic, antipyretic and anti-inflammatory agent that inhibits platelet aggregation
  • Toxicity occurs at 150 mg/kg
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77
Q

What are the 8 s/s of aspirin poisoning?

A
  • Tachycardia
  • Tachypnea
  • N/V
  • Neurological
  • Tinnitus (often FIRST SIGN)
  • Diaphoresis, hyperpyrexia
  • Bleeding tendencies
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78
Q

How do you treat aspirin poisoning even though there is no antidote?

A
  • Treat elevated body temperature
  • Administer activated charcoal
  • Administer IV sodium bicarbonate
  • IV fluids (dextrose and saline)
  • Administer IV vitamin K
  • If sever, hemodialysis may be needed
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79
Q

Why is lead poisoning dangerous?

A

• Lead interferes with normal cell function (mostly NS) and affects the metabolism of vitamin D and calcium

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80
Q

What are the 6 s/s of lead poisoning?

A 
o	Loss of developmental skills
o	Behavior, attention problems
o	Hearing loss
o	Kidney damage
o	Reduced IQ 
o	Slowed body growth
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81
Q

What 2 interventions can be done to prevent lead poisoning?

A
  • Environmental hx

* Interventions to remove lead from environment

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82
Q

What 3 medications can be given to treat lead poisoning?

A

• Dimercaptol (BAL): given Deep IM
• Pemicilliamine: given PO
• Succimer (DMSA): given PO
**also maintain adequate hydration

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83
Q

What is the difference between meningitis and encephalitis?

A

Meningitis is the inflammation AROUND the brain (spinal cord) and encephalitis is inflammation of the brain

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84
Q

What 2 signs are used to identify meningitis?

A

• Positive Kernig or Brudzinski sign
K: cannot straighten leg when the hip is 90 degees
B: when the neck flexes, the hips and legs flex

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85
Q

What scale is used to determine neuro status of a patient with meningitis?

A

Pediatric Glasgow coma scale

86
Q

What is the treatment to meningitis?

A

Bacterial antibiotics IV (treat everyone who came into contact with patient)
viral is supportive

87
Q

What are the 8 s/s of encephalitis?

A
  • Confusion
  • Headache
  • High fever
  • Photophobia
  • Lethargy
  • Nuchal rigidity
  • Seizures
  • Coma
88
Q

What are the 4 interventions used to treat patient with encephalitis?

A
  • Initial seizure precautions for cerebral edema and increase ICP
  • Viral encephalitis treated with antiviral medication such as acyclovir (Zovirax)
  • Encephalitis of bacterial origin is treated with narrow-spectrum antibiotics
  • Be aware of rapid neuro changes
89
Q

What is Reye’s syndrome?

A

• Viral illness that causes swelling of the brain and fatty damage to the liver primarily caused by the administration of aspirin

90
Q

How do you treat Reye’s syndrome?

A

-avoid aspirin
-IVF
-ibuprofen
-monitor liver
-glucose (low)
-monitor ICP
monitor liver function

91
Q

What is Fifth Disease?

A
  • also called slapped cheek disease

- a rash caused by parovirus B19

92
Q

How is fifth disease transmitted?

A

respiratory secretions (use droplet precautions)

93
Q

How long is the incubation period for fifth disease?

A

4-12 days (contagious before rash shows)

94
Q

What education should be taught to the child about fifth disease?

A

-stay away from pregnant women

95
Q

What 4 s/s are shown in fifth disease?

A
  • high fever
  • sore throat
  • headache
  • macular (flat), lacy rash
96
Q

How is Chickenpox (varicella) transmitted?

A

airborne and contact

97
Q

How long is incubation for chickenpox?

A

21 days (highly contagious from 1 to 2 days before the appearance of a rash until all blisters are dry (4-6 days))

98
Q

What are 3 s/s of chickenpox?

A
  • pruritic
  • fever
  • ulcers
99
Q

what are 4 interventions for chickenpox?

A
  • Administer antihistamines
  • Dress child loose fitting, lightweight clothes
  • Do not give ASA or salicylates
  • IV Immunoglobulin cases of immunocompromised or pregnant
100
Q

What are the 3 modes of transmission for Rubella (german measles)?

A
  • placental if congenital
  • pharyngeal secretions (droplet) if postnatal
  • direct contact with secretions
101
Q

What is the incubation period of rubella?

A

14-21 days

102
Q

What are the 4 s/s of rubella?

A
  • Prodromal (occurs before labor): mild fever, sore throat, eye pain, GI upset
  • Lymphadenopathy with the presence of post auricular nodes
  • Rash fine, light pink maculopapular on face and then spreads to chest and entire body
  • Forchheimer spots (small red spots) on soft palate
103
Q

What 2 diagnostic test would be used to assess it is rubella?

A
  • nasal swab

- detection of IgM or IgG antibodies

104
Q

How would you treat rubella?

A

supportive care (antipyretics, bed rest, fluids)

105
Q

What is the incubation period of Rubeola (measles)?

A

8-12 days

106
Q

What are the 7 s/s of rubeola?

A

• Prodromal phase (4-5 days): cough, fever, rhinitis, conjunctivitis
• Koplik spots (buccal mucosa) 2 days prior to onset of rash (looks like tine grains of sand surrounded by red rings)
• Anorexia
• Malaise
• Fatigue
• Generalized lymphadenopathy
• Rash stage (lasts 3 days) with fever (105)
o Forehead and behind ears
o Face, trunk, upper and lower extremities
o After 4-7 days, rash begins to fade and temperature decreases

107
Q

What are the 3 nursing interventions that can be done to help treat rubeola?

A
  • Keep room dark
  • Isolate while disease is active (1 week from start of rash)
  • Supportive care
108
Q

What are the 5 differences between Rubella and Rubeola?

A

Rubella has low fever or no fever/ Rubeola has high fever

  • Rubella rash begins on face/ Rubeola rash begins on hairline
  • Rubella has forchheimer spots on soft palate; rubeola has Koplik spots on buccal mucosa
  • rubella is droplet; rubeola is airborne
  • -rubella has a headache; rubeola has conjunctivitis
109
Q

How do you transmit mumps (Parotitis)?

A

droplet

110
Q

What are the 7 s/s of mumps?

A
  • Malaise
  • Low fever
  • Anorexia
  • Ear pain
  • Pain when chewing
  • Headache
  • Bilateral or unilateral parotid glandular swelling )as disease progresses); swelling peaks on day 3 and lasts up to 6 days
111
Q

What are the 4 treatments of mumps?

A
  • ibuprofen
  • acetaminophen
  • increase fluid intake
  • encourage soft foods
112
Q

What are the 5 s/s of scarlet fever?

A 
•	Fever/ headache
•	Sore throat/ tender cervical nodes
•	Rhinitis
•	Vomiting
-rash
113
Q

How would you describe the rash of someone with scarlet fever?

A

• Characteristics of rash: diffuse, finely popular, erythematous eruption, blanches on pressure, feels like sandpaper

114
Q

What are 3 interventions to treat scarlet fever?

A
  • Administration of antibiotics
  • Supportive care for throat pain and fever
  • AVOID ASPIRIN
115
Q

What are the 5 interventions that can be done with a dog bite?

A
  • Clean with soap and water; rinse thoroughly
  • Cover wound with topical antibiotic and lean dressing
  • Tetanus booster may be needed
  • Assess for signs of infection
  • Contact local health department
116
Q

What 5 s/s are in lyme disease?

A
  • Headache
  • Fatigue
  • Anorexia
  • Stiff neck
  • Progresses to systematic involvement 2-11 weeks later
117
Q

What are 3 interventions to treat lyme disease?

A
  • Remove tick
  • Clean area with soap and water; save ticks
  • Oral antibiotics if infection is suspected
118
Q

If you are less than 8 years old with Lyme disease, what medications are given?

A

o Give amoxicillin or Cefuroxime

119
Q

If you are over 8 years old, what medications are given if you have Lyme disease?

A

o Give doxycycline or tetracycline

120
Q

What 2 things would you educate patient about Lyme disease?

A
  • Wear long pants and short sleeves while in wooded areas

* Shower with soap after being in wooded areas or near outside pets

121
Q

What is a hypospadias/ epispadias?

A

H: meatus (opening) underneath penis
E: meatus (opening) above the penis

122
Q

What are the 5 interventions that can be taken for a patient with hypospadias?

A
  • give nerve block/ acetaminophen for pain
  • put in catheter to drain to diaper
  • once stent comes out, may resume bathing
  • encourage fluid intake
  • may see blood in the urine
123
Q

What is cryptorchidism?

A

testes fail to descend

124
Q

How would you treat cryptorchidism?

A

• Treatment is orchiopexy: (small incision in the abdomen to allow testicle to distend)
o surgical procedure around 6 months-12 months

125
Q

What is bladder exstrophy?

A

• externalization of the bladder with exposed lower urinary tract

126
Q

What temporary fix can be done to help treat bladder exstrophy?

A

urine diversion called vesicostomy (• A small opening in the lower abdomen below the belly button to allow urine to drain out from a child’s bladder. This usually is done when an infant or young child has problems emptying his or her bladder)

127
Q

If someone had a bladder exstrophy, what are the 5 interventions that can be done for this patient?

A
  • Frequent diaper changes
  • Position: supine
  • Use plastic wrap
  • Clean intermittent catheterization
  • Manage bladder spasms with anticholinergics
128
Q

What 3 educational practices should the nurse tell the parents to do to help care for child with bladder exstrophy?

A

• care for catheter:
o avoid kinks, proper use of drainage bag, avoid pulling
• NO tub baths
• Encourage fluid intake

129
Q

What is nephrotic syndrome (nephrosis)?

A

increase in permeability of the glomerulus to allow proteins in

130
Q

What are the 9 s/s of nephrosis

A
  • Proteinuria
  • Hypoalbuminemia and hypoalbuminemia
  • Hyperlipidemia
  • Edema (rapid or gradual)
  • Microscopic hematuria
  • Pale
  • Irritable
  • Decrease appetite
  • Tired
131
Q

What would you expect if someone had nephrosis (3)?

A
  • low urine output
  • fluid retention
  • normal to low BP (may become high after giving corticosteroids)
132
Q

What is the diet for someone who has nephrosis (4)?

A
  • low fat
  • sodium restricted
  • encourage protein intake
  • restrict fluids
133
Q

What are 5 educational teachings to help someone with nephrosis?

A
  • Treat underlying cause (give corticosteroids)
  • Give vaccinations (delay live vaccination because risk of infection)
  • Demonstrate dipstick
  • Avoid infectious people
  • Provide emotional support
134
Q

What is glomerulonephritis (nephritis)?

A

immune process that causes inflammation which damage glomeruli

135
Q

What does the acronym HAD STREP mean for someone who has nephritis?

A
  • Hypertension
  • ASO titer
  • Decrease glomerular filtration
  • Swelling
  • Tea color urine or cola colored
  • Recent strep.
  • Elevate BUN and creatinine
  • Proteinuria
136
Q

What are the 6 s/s of nephritis?

A

pallor, headache, irritability, lethargy, abdominal discomfort, loss of appetite

137
Q

What is the diet for nephritis (2)?

A

low sodium

low protein

138
Q

What are the s/s of an infant with UTI (2)?

A
  • poor feeder

- smelly urine

139
Q

What is the s/s of an older child with UTI have?

A

 Might not want to go to the bathroom because of the pain

140
Q

What would be educated to patients with UTI (5)?

A
  • No tub baths or harsh soaps
  • Wipe front to back
  • Hydration
  • Constipation prevention
  • Sexual activity prevention strategies (urinate before and after sex)
141
Q

What is Vesicoureteral Reflux?

A

flow of urine goes teh wrong way

142
Q

What are the 3 treatments to Vesicoureteral Reflux?

A

• Surgical: to prevent damage to the kidney
• Urine catheter placed initially after treatment
o Might see blood, which is typical to see
• Endoscopic management with injection of Deflux
o Helps stretch out ureter

143
Q

If a pregnant patient has syphilis, what birth defects can it cause (3)?

A

 IUGR
 Preterm
 Stillbirth

144
Q

How would you treat someone with syphilis?

A
  • PCN IM if less than one year old

* IF more than one year, give PCN once a week for 3 weeks

145
Q

How to treat syphilis if allergic to PCN?

A

allergic to PCN and not pregnant:
o Give doxycycline or tetracycline
• If allergic to PCN and pregnant:
o PCN desensitization in a hospital is necessary

146
Q

What are the 4 s/s of chlamydia?

A

o Mostly asymptomatic
o Burning/ frequent urination
o Purulent discharge
o Friable cervix (bleeds easily and causes painful sex; may have spotting after periods and bleeding after sex)

147
Q

What is the treatment for chlamydia (4)?

A

o Single gram dose of Zithromax or doxycycline BID for 7 days
o Partner also needs to be treated and refrain sex for a week
o Doxycycline is contraindicated in pregnancy
o Phototoxic: wear long sleeves in the car

148
Q

What is gonorrhea?

A
  • Aka the clap
  • Causes pelvic inflammatory disease in nonpregnant woman and ascend vertically to cause pelvic inflammatory disease once the membranes rupture in pregnant woman
149
Q

What are the 7 s/s of gonorrhea?

A 
o	Green foul odor purulent
o	Dysuria
o	Urinary frequency
•	Women
o	Edema of urethra
•	Male:
o	Burning after urination 
o	Presence of discharge
•	Babies may develop ophthalmia (inflammation of the eye)
150
Q

What are the 3 treatments for gonorrhea?

A
  • Ceftriaxone 200mg IM and 1-gram Zithromax (chlamydia usually occurs with gonorrhea)
  • All partners need to be treated
  • Newborns treated with erythromycin (ointment)
151
Q

What are the risk factors for group B streptococcus (7)?

A 
o	Being young
o	African American/ Hispanic
o	Preterm labor
o	PROM (preterm rupture of the membrane)
o	Intrapartum fever
o	Previous hx of infected baby
o	GBS bacteriuria in current pregnancy
152
Q

When should the mother be screened for group b strep?

A

• Secondary prevention: screening for vaginal and rectal GBS colonization between 35-37 weeks (reason: infection can be transient has a reduced predictive power for infection at birth) – lemans terms: it would make it harder to detect GBS if done later than 35-37 weeks

153
Q

What is the treatment for GBS?

A

PCN
• PCN given on onset of birth and continued every 4 hours until childbirth
• If GBS status is unknown, PCN is given as a prophylaxis and labor is premature for less than 37 weeks, mother has a fever of 104 or higher, membrane ruptured in less than 18 hours
• If history of previous infected baby, PCN should be started and screening should be skipped
• Intrapartum PCN is also given

154
Q

If mom has GBS and allergic to PCN, what is the treatment?

A

• IF allergic, Clindamycin and erythromycin are tested for susceptibility. If that does not work, vancomycin is given IV twice per day until baby is born

155
Q

What is Bacterial Vaginosis?

A
  • inflammation of the vagina caused by overgrowth of the bacteria
  • not an STI
  • good bacteria (lactobacilli) is gone possibly caused by deodorant and douching (spraying inside of vagina with fluids) or other causes
  • has a fishy smell
156
Q

How does Bacterial Vaginosis affect pregnancy (2)?

A

PROM or Preterm birth

157
Q

How is Bacterial Vaginosis treated?

A

Metronidazole (oral or vaginal cream) or clindamycin can be used

158
Q

What would you teach someone with Bacterial Vaginosis (3)?

A

-avoid intercourse, use condom, wash hands

159
Q

How do you treat UTI (4)?

A

Treatment- nitrofurantoin for 5 days

  • trimethoprim and sulfamethoxazole may be used
  • fluoroquinolone: primary treatment; if that does not work, gentamycin or ceftriaxone is given
  • Pyridium is used for pain: may cause urine to turn orange
160
Q

What is Metritis (endometritis and Parametritis)

A

endometritis (puerperal fever)
-an infection that causes an inflammation in the inner lining of the uterus
Parametritis
Pelvic cellulitis ascends from metritis (connective tissue infection)- may be palpable

161
Q

What causes endometritis (5)?

A
  • Trauma
  • Staples
  • Multiple vaginal exams
  • Premature rupture
  • Any invasive procedures
162
Q

What causes parametritis?

A

-Caused by blood clot in pelvic vein that can be infected and necrotic

163
Q

What does REEDA stand for?

A

Examine redness, edema, ecchymosis, discharge, wound approximation
*for parametritis

164
Q

What s/s are found in metritis (8)?

A
  • Chills and fever
  • Decrease in appetite
  • Headache/ backache
  • Prolonged afterpains
  • Tender/ large uterus
  • Foul odor
  • Ileus
  • Elevated EBC (exhaled breath condensation -pH values)
165
Q

What is mastitis?

A

inflammation of the breast

166
Q

What educational teachings should be done to patients with mastitis?

A
  • Wear loose clothes
  • Don’t miss any feedings
  • Wash hands
  • Rest
167
Q

What are the 5 signs and symptoms of fungal mastitis?

A

nipple pain, stabbing pain between feedings, milk may smell yeasty, infected breast becomes pink shiny, pruritic and flaky

168
Q

How do you treat mastitis (6)?

A

NSAIDS, warm moist compress or ice, increase in fluid intake, penicillin or Keflex

169
Q

What medication should be given to the baby and mother if mom has mastitis?

A

Candida infection: oral Nystatin for the baby and antifungal cream or ointment for the mother (wash off and dry before breastfeeding)

170
Q

What causes mastitis (5)?

A
  • caused by trauma through the nipple, incorrect latching, cracked nipple, poor hygiene, stress, missed feedings; if treatment fails use diflucan
  • **belladonna is poisonous and not recommended treatment
171
Q

Should the mother stop breastfeeding if she has mastitis?

A

No. continue feeding as normal

172
Q

How can you get Hepatitis A?

A

Route: fecal, oral

-sharing needles

173
Q

How can you get Hepatitis B?

A

-route: bloodborne pathogen transmitted primarily through sex or needles

174
Q

When should the Hepatitis B vaccine be given?

A

All pregnant women should be screened and given Hep B immunoglobulin IgM vaccine within 12 hours of birth to prevent babies becoming chronic carriers

175
Q

What is the difference between Herpes type 1 and herpes type 2?

A
  • Type one presents as a cold sore that can be transmitted through kissing
  • type 2 can be from genital herpes
176
Q

What are the similarities between type one and two herpes (8)?

A

• STI
• Painful
• Skin to skin infection
• Itch and tingling
• Primary infection most dangerous for fetus
o Then becomes dormant, and can flare up from stress, pregnancy, poor health, frequent sex, overheating, tight clothes
• Treat with antivirals (acyclovir); giving acyclovir 36 weeks and on during pregnancy to reduce need for C-section
o If mother develops prodromal symptoms or active lesions, have to have C-section
• If infant is infected within the first-second month of life, babies can develop hypo/hyperthermia and vesicular lesions
• Teach patient to wear cotton underwear or none at all, loose clothes, genital area clean and dry to promote lesion healing

177
Q

What are venereal warts?

A

STI caused by HPV type 6 and 11

-Cauliflower like lesions on the penis or vagina

178
Q

What is one treatment used to treat Venereal warts? What are two treatments that act as a teratogen? what is used to remove lesions?

A

• Podofilox (comes from juniper tree)
• Sinecatechins (green tea leaves)
o DO NOT use during pregnancy because they are teratogenic
o Use cryotherapy to remove lesions
• Gardasil approved vaccine given before becoming sexually active

179
Q

What treatments can be given for HIV (3)?

A

Hep-B vaccine, pneumococcal vaccine and flu shot should be given

180
Q

What should be avoided if you have HIV?

A

-avoid invasive procedures. At risk for hemorrhage and poor wound healing

181
Q

What is candidiasis?

A

yeast infection

182
Q

What are 5 factors can lead to candidiasis?

A 
	Pregnancy
	Diabetes
	Immunosuppressants
	Antibiotic use
	Douching
183
Q

What should you educate a patient with candidiasis (3)?

A

• Educate patient to wear cotton underwear, avoid powders, and add yogurt and probiotics to replenish flora

184
Q

How do you treat candidiasis when thrush shows up?

A

o Treat: nystatin rinse/ swallow

185
Q

What is used to treat candidiasis (4)?

A

o Treated with clotrimazole cream or miconazole cream/ suppository, tioconazole ointment
o Weak solution of sodium bicarbonate may give pain relief

186
Q

What is trichomonas? What happens if it is untreated?

A

a protozoan STI that shows as a yell-greenish frothy smelly discharge

-Untreated, can cause PROM, preterm birth and low birth weight

187
Q

What should you avoid if you have trichomonas?

A

avoid alcohol and sex

188
Q

What is toxoplasmosis? What happens if it is untreated?

A

a protozoan that is NOT an STI

  • obtain it from undercooked/ raw meat or from cat feces
  • untreated can lead to fetal death
189
Q

What are the three treatments used to treat toxoplasmosis?

A

-pyrimethamine (antiparasitic med.), sulfadiazine (antibiotic), folinic acid (reduce toxicity effects of pyimethamine)

190
Q

What does the TORCH acronym mean?

A 
Describes infections that cause harm during pregnancy
Toxoplasmosis 
Other: (syphilis, hepatitis, HIV)
Rubella
Cytomegalovirus
Herpes Simplex
191
Q

What is thrombophlebitis?

A

• Blood clot in response to inflammation in a vein wall (can be deep or superficial)

192
Q

What is Virchow’s triad?

A

factors that lead to thrombosis: vessel wall injury, hyper coagulation of blood, stasis of blood

193
Q

If you have a mental illness and are breastfeeding, what medication is okay to take?

A

SSRI (Zoloft)

194
Q

When breastfeeding what do you need to watch out for when taking benzos?

A

if the fetus has withdrawal symptoms

195
Q

Can you be on medication if you want to breastfeed and you have schizophrneia?

A

• Clozapine and Haldol (do not be on medication if you want to breastfeed and affects fetus) – a higher dose is recommended more than taking multiple medications if they need to take medication because multiple increases the risk to exposure to the fetus

196
Q

What is the difference between postpartum blues and postpartum depression?

A

Postpartum Blues:
• Aka Baby blues
o Occurs in the first 2-4 weeks of childbirth
o Encourage that the mood is temporary
o If it does not resolve, may need to see physician to see if it is postpartum depression
Postpartum Depression:
• Intense and pervasive sadness with intense fears and anger persistent for multiple weeks.
• Length: 2-6 months that can extend to one year

197
Q

What is postpartum psychosis?

A
  • Increase depression with thought of hurting self and/ or infant
  • Develop delusions and hallucinations
  • Appears within the first 8 weeks postpartum
  • Identify if there is a plan and if there is any equipment she has access to to carry out the plan
198
Q

What drug can cause premature rupture of the amniotic sac?

A

cocaine

199
Q

What are 6 s/s of neonatal withdrawal?

A

o High pitch/ shrill cry
o GI disturbance (diarrhea, vomiting)
o Tremulousness (shaking)
o Excoriation (skin picking)of knees, chin, and elbows
o Respiratory disturbance (frequently wants to suck, sneezing, yawning, hiccups)
o Seizure activity

200
Q

What is neonatal abstinence syndrome?

A

a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother’s womb

201
Q

What CNS s/s would you see in NAS (7)?

A 
o	Sleep pattern disturbance
o	Hyperactivity
o	Tremors
o	Increase muscle tone
o	Myoclonic jerks
o	Shrill cry
o	convulsion
202
Q

What Respiratory s/s would you see in NAS(4)?

A

o nasal flaring
o sneezing
o tachypnea
o hiccups, yawning

203
Q

What GI s/s would you see in NAS (4)?

A

o Vomiting (make sure to elevate head to prevent aspiration)
o Diarrhea
o Poor feeding
o Excessive sucking

204
Q

What metabolic s/s would you see in NAS (6)?

A 
o	Fever
o	Hypoglycemia
o	Mottling
o	Sweating
o	Yawning
o	Vasomotor instability (place in a quiet environment and swaddling with their hands toward their mouth)
205
Q

How much alcohol is safe to consume while pregnant?

A

No amount of alcohol

206
Q

What can drinking alcohol cause in the infant?

A

leading known cause of mental retardation

207
Q

What s/s are related to FAS(6) (what do they look like)?

A

o s/s: underdeveloped jaw, small head, low nasal bridge, small eye opening, short nose, poor impulse control

208
Q

How would you treat neonate with FAS (3)?

A

-swaddle, reduce stimuli, supportive measures

209
Q

What should the nurse educate the patient on who has FAS regarding breastfeeding (7)?

A 
o	May pass through the milk
o	Watch out for intoxication
o	Poor feeder
o	Amphetamine (may cause irritability and poor sleeping)
o	Cocaine (vomiting, diarrhea, irritability, tremors, hyperactive, hypertension)
o	Heroin (hypertonia, opisthotonos (spasm of head going backwards)
o	Nicotine (reduces ability for fetus to bounce back from hypoxic episodes)
210
Q

What are the 9 factors that may lead to an episiotomy?

A
  • primigravida
  • shoulder dystocia
  • macrosomia
  • vaccuum
  • forceps
  • occiput-posterior position (baby comes out butt first)
  • lithotomy
  • breathing
  • limit the second stage of pregnancy
211
Q

What 6 interventions can be taken to mitigate episiotomy?

A
  • perineal massage
  • natural pushing
  • push and breathe slowly
  • avoid pushing immediately after epidural placement
  • warm compression
  • side-lying

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