Test 5 Flashcards
1
Q
What is the difference between a hypotonic and a hypertonic labor pattern
A
Hypertonic=stronger contraction
Hypotonic weaker contraction
2
Q
What are 2 interventions used to treat shoulder dystocia?
A
stop Oxytocin and turn to left side
3
Q
What does tachysystole mean?
A
Contractions greater than 5 in a span of 10 minutes over 30 minutes
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
5
Q
What position should the mother be in if she has an umbilical cord prolapse?
A
McRobert’s position
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
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
8
Q
What are the three hallmark signs of tracheoesophageal fistula? (3C)
A
cyanosis, choking, coughing
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
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
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
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)
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
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
15
Q
How is rotavirus transmitted?
A
Feco-oral
16
Q
What are the 3 signs and symptoms of rotavirus?
A
diarrhea
vomiting
fever
17
Q
What are the treatment options for rotavirus (2)?
A
hand wash and fluids
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
19
Q
Why don’t you give antimotility drugs to someone with gastroenteritis?
A
retain bacteria (have diarrhea to excrete bacteria)
20
Q
What is pyloric stenosis?
A
INflammation between the opening of the stomach and small intestines causing an obstruction
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
22
Q
In constipation, what medication can be used?
A
miraLAX (polyethylene glycol)
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
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
25
What are the 2 s/s of inguinal hernia?
• Severity respiratory distress and pulmonary hypoplasia (lungs do not fully develop)
26
What are 3 nursing interventions for an umbilical hernia?
• 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)
27
What cannot people with celiac disease absorb?
vitamin ADEK, fat
28
What types of food should be recommended to a patient with celiac disease?
* Gluten free diet (no wheat, barley, rye, and oats)
| * Corn, millet and rice are acceptable
29
What are the 5 s/s of crohns disease?
```
• Abdominal pain
• Diarrhea
• N/V
-weight loss
• Test for anemia
```
30
What are the 3 interventions for crohns disease?
* Aminosalicylates (Asacol) - nsaid
* Corticosteroids (decrease inflammation)
* Bowel rest and provide TPN
31
What is the recommended diet for crohn's and ulcerative colitis disease?
• High carb, High protein, low fiber, normal fat
32
What is Hirschsprung Disease?
• Missing nerve cells in the colon causing difficulty to pass stools
33
What is the 4 s/s of Hirschsprung disease?
* Failure to pass meconium with the first 48 hours
* Failure to thrive
* Poor feeding
* Chronic constipation, vomiting and abdominal pain
34
What is intussusception?
Intestines goes inside itself
35
What are the 5 s/s of intussusception?
- 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)
36
What is McBurney's point?
pain felt when palpating RLQ used to diagnose appendicitis
37
What is obturator sign?
pain felt when turning hips used to diagnose appendicitis
38
What is rebound tenderness for appendicitis?
Pain felt when pressure is let go on RLQ
39
What is Psoa's sign and what does it indicate?
• Positive Psoas sign (lay on left side while right thigh is flexed backwards) the pain indicates swollen appendix
40
What is Ravsing sign?
when palpating LLQ, pain is felt on RLQ for appendicitis
41
What are the 4 interventions for appendicitis?
* Position semifowler or right side-lying position
* DO NOT APPLY HEAT
* Antibiotics
* Prepare for surgery
42
What are the 2 s/s of appendicitis
absent bowel sounds, abdominal distention
43
What is peritonitis?
Bacterial infection after the rupture of an abdominal organ
44
What are the 10 s/s of peritonitis?
* 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
45
What does communicable disease mean?
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)
46
What are the three factors of a communicable disease?
* Infectious agent or pathogen
* An effective means of transmission
* Presence of a susceptible host
47
What are 5 live (attenuated) vaccine names?
```
o Chickenpox
o MMR
o Rotavirus
o Smallpox
o Yellow fever
```
48
What are 3 inactivated vaccines?
o Hep A
o Flu
o Polio (shot)
49
What is a recombinant/ conjugated vaccine and name three?
o Uses certain part of the gene such as the protein
o HPV
o Pertussis
o Pneumococcal/ meningococcus
50
What is a toxoid vaccine and name 2?
-uses toxins to build anitbodies
o Diphtheria
o Tetanus
51
Name 5 types of rash descriptions?
* Vesicles- small fluid like sac
* Papule- circular elevated to skin
* Macule- flat lesion
* Pustule- purulent filled sac
* Petechiae – pinpoint red spots
52
What is the mode of transmission for conjunctivitis?
contact with secretions hand to eye (highly infectious, need to be treated)
53
What are the 5 s/s of conjunctivitis?
* Edema of eyelid/ eye conjunctiva
* Enlarged lymph nodes
* Mucopurulent exudate
* Itching, burning, photophobia
* No change in vision
54
How do you diagnose conjunctivitis?
gram stain if it is from herpes or chlamydia
55
What is the treatment for conjunctivitis?
* Antibiotics administered to the eyes
* Cannot go back to school until taken antibiotics for 24 hours
* Hand hygiene and avoid sharing towels
56
What is Giardia?
• Cysts are ingested and passed into the duodenum and proximal jejunum where they begin actively feeding; excreted in the stool
57
What are the 4 modes of transmission for giardia?
person to person contact, unfiltered water, improperly prepared food, contact with animals
58
What are the 3 s/s for giardia in infants?
diarrhea, vomiting, anorexia, FTT (failure to thrive)
59
What are the 2 s/s in older children who have giardia?
abdominal cramps, and intermittent loose, foul smelling, watery, greasy stool
60
How long do the s/s last for giardia and how do you diagnose it?
* Symptoms lasts 2-6 weeks
| * Stool specimen obtained on three separate days
61
What are the 4 treatments for giardia?
* Metronidazole (Flagyl)
* IV hydration
* Correction of electrolytes
* Use gloves
62
When can the child go back to school if they have giardia?
Once the diarrhea goes away
63
what are pinworms?
* 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
64
What 2 s/s would you see if the patient has pinworms?
intense pruritis at night and irritability/ restlessness
65
What 3 diagnoses would be used to test for pinworm?
* Look for worms 2-3 hours after child is asleep
* 3 part tape test
* Examine fingernails often child under a microscope for eggs
66
what are 4 things you can educate the patient on when they have pinworms?
* Hand hygiene after bathroom and before eating
* Wash all raw fruits and vegetables
* Dogs/ cats (clean them and litterbox)
* Wash after swimming
67
what are 2 treatment options needed for someone with pinworm?
* Albendazole, mebendazole (repeat after 2 weeks)
| * Whole family has to be treated
68
What are scabies?
mites that tunnel under skin
| *contact precaution
69
What are 2 s/s of scabies?
• Intense pruritis with scabbing linear patterns
70
What are 3 treatments for scabies?
* 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
71
What is Pediculosis Capitis?
Lice, Child is excused if they have lice; not excused by the eggs
72
What are the 2 treatments for Pediculosis Capitis?
NIX, permethrin 1%
73
What is acetaminophen?
* Acetaminophen is an analgesic, antipyretic agent; metabolized in liver
* Hepatotoxicity: greater than 200
74
What are the 5 s/s of acetaminophen poisoning?
* N/V
* Diaphoresis
* Pallor
* RUQ pain
* Jaundice
* Confusion/ stupor
* Coagulation abnormalities
75
What is the antidote for acetaminophen poisoning?
acetylcysteine (MUCOMYST)
| -activated charcoal can be used as well
76
What is aspirin?
* Analgesic, antipyretic and anti-inflammatory agent that inhibits platelet aggregation
* Toxicity occurs at 150 mg/kg
77
What are the 8 s/s of aspirin poisoning?
* Tachycardia
* Tachypnea
* N/V
* Neurological
* Tinnitus (often FIRST SIGN)
* Diaphoresis, hyperpyrexia
* Bleeding tendencies
78
How do you treat aspirin poisoning even though there is no antidote?
* 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
79
Why is lead poisoning dangerous?
• Lead interferes with normal cell function (mostly NS) and affects the metabolism of vitamin D and calcium
80
What are the 6 s/s of lead poisoning?
```
o Loss of developmental skills
o Behavior, attention problems
o Hearing loss
o Kidney damage
o Reduced IQ
o Slowed body growth
```
81
What 2 interventions can be done to prevent lead poisoning?
* Environmental hx
| * Interventions to remove lead from environment
82
What 3 medications can be given to treat lead poisoning?
• Dimercaptol (BAL): given Deep IM
• Pemicilliamine: given PO
• Succimer (DMSA): given PO
**also maintain adequate hydration
83
What is the difference between meningitis and encephalitis?
Meningitis is the inflammation AROUND the brain (spinal cord) and encephalitis is inflammation of the brain
84
What 2 signs are used to identify meningitis?
• 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
85
What scale is used to determine neuro status of a patient with meningitis?
Pediatric Glasgow coma scale
86
What is the treatment to meningitis?
Bacterial antibiotics IV (treat everyone who came into contact with patient)
viral is supportive
87
What are the 8 s/s of encephalitis?
* Confusion
* Headache
* High fever
* Photophobia
* Lethargy
* Nuchal rigidity
* Seizures
* Coma
88
What are the 4 interventions used to treat patient with encephalitis?
* 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
What is Reye's syndrome?
• Viral illness that causes swelling of the brain and fatty damage to the liver primarily caused by the administration of aspirin
90
How do you treat Reye's syndrome?
-avoid aspirin
-IVF
-ibuprofen
-monitor liver
-glucose (low)
-monitor ICP
monitor liver function
91
What is Fifth Disease?
- also called slapped cheek disease
| - a rash caused by parovirus B19
92
How is fifth disease transmitted?
respiratory secretions (use droplet precautions)
93
How long is the incubation period for fifth disease?
4-12 days (contagious before rash shows)
94
What education should be taught to the child about fifth disease?
-stay away from pregnant women
95
What 4 s/s are shown in fifth disease?
- high fever
- sore throat
- headache
- macular (flat), lacy rash
96
How is Chickenpox (varicella) transmitted?
airborne and contact
97
How long is incubation for chickenpox?
21 days (highly contagious from 1 to 2 days before the appearance of a rash until all blisters are dry (4-6 days))
98
What are 3 s/s of chickenpox?
- pruritic
- fever
- ulcers
99
what are 4 interventions for chickenpox?
* Administer antihistamines
* Dress child loose fitting, lightweight clothes
* Do not give ASA or salicylates
* IV Immunoglobulin cases of immunocompromised or pregnant
100
What are the 3 modes of transmission for Rubella (german measles)?
- placental if congenital
- pharyngeal secretions (droplet) if postnatal
- direct contact with secretions
101
What is the incubation period of rubella?
14-21 days
102
What are the 4 s/s of rubella?
* 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
What 2 diagnostic test would be used to assess it is rubella?
- nasal swab
| - detection of IgM or IgG antibodies
104
How would you treat rubella?
supportive care (antipyretics, bed rest, fluids)
105
What is the incubation period of Rubeola (measles)?
8-12 days
106
What are the 7 s/s of rubeola?
• 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
What are the 3 nursing interventions that can be done to help treat rubeola?
* Keep room dark
* Isolate while disease is active (1 week from start of rash)
* Supportive care
108
What are the 5 differences between Rubella and Rubeola?
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
How do you transmit mumps (Parotitis)?
droplet
110
What are the 7 s/s of mumps?
* 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
What are the 4 treatments of mumps?
- ibuprofen
- acetaminophen
- increase fluid intake
- encourage soft foods
112
What are the 5 s/s of scarlet fever?
```
• Fever/ headache
• Sore throat/ tender cervical nodes
• Rhinitis
• Vomiting
-rash
```
113
How would you describe the rash of someone with scarlet fever?
• Characteristics of rash: diffuse, finely popular, erythematous eruption, blanches on pressure, feels like sandpaper
114
What are 3 interventions to treat scarlet fever?
* Administration of antibiotics
* Supportive care for throat pain and fever
* AVOID ASPIRIN
115
What are the 5 interventions that can be done with a dog bite?
* 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
What 5 s/s are in lyme disease?
* Headache
* Fatigue
* Anorexia
* Stiff neck
* Progresses to systematic involvement 2-11 weeks later
117
What are 3 interventions to treat lyme disease?
* Remove tick
* Clean area with soap and water; save ticks
* Oral antibiotics if infection is suspected
118
If you are less than 8 years old with Lyme disease, what medications are given?
o Give amoxicillin or Cefuroxime
119
If you are over 8 years old, what medications are given if you have Lyme disease?
o Give doxycycline or tetracycline
120
What 2 things would you educate patient about Lyme disease?
* Wear long pants and short sleeves while in wooded areas
| * Shower with soap after being in wooded areas or near outside pets
121
What is a hypospadias/ epispadias?
H: meatus (opening) underneath penis
E: meatus (opening) above the penis
122
What are the 5 interventions that can be taken for a patient with hypospadias?
- 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
What is cryptorchidism?
testes fail to descend
124
How would you treat cryptorchidism?
• Treatment is orchiopexy: (small incision in the abdomen to allow testicle to distend)
o surgical procedure around 6 months-12 months
125
What is bladder exstrophy?
• externalization of the bladder with exposed lower urinary tract
126
What temporary fix can be done to help treat bladder exstrophy?
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
If someone had a bladder exstrophy, what are the 5 interventions that can be done for this patient?
* Frequent diaper changes
* Position: supine
* Use plastic wrap
* Clean intermittent catheterization
* Manage bladder spasms with anticholinergics
128
What 3 educational practices should the nurse tell the parents to do to help care for child with bladder exstrophy?
• care for catheter:
o avoid kinks, proper use of drainage bag, avoid pulling
• NO tub baths
• Encourage fluid intake
129
What is nephrotic syndrome (nephrosis)?
increase in permeability of the glomerulus to allow proteins in
130
What are the 9 s/s of nephrosis
* Proteinuria
* Hypoalbuminemia and hypoalbuminemia
* Hyperlipidemia
* Edema (rapid or gradual)
* Microscopic hematuria
* Pale
* Irritable
* Decrease appetite
* Tired
131
What would you expect if someone had nephrosis (3)?
- low urine output
- fluid retention
- normal to low BP (may become high after giving corticosteroids)
132
What is the diet for someone who has nephrosis (4)?
- low fat
- sodium restricted
- encourage protein intake
- restrict fluids
133
What are 5 educational teachings to help someone with nephrosis?
* Treat underlying cause (give corticosteroids)
* Give vaccinations (delay live vaccination because risk of infection)
* Demonstrate dipstick
* Avoid infectious people
* Provide emotional support
134
What is glomerulonephritis (nephritis)?
immune process that causes inflammation which damage glomeruli
135
What does the acronym HAD STREP mean for someone who has nephritis?
* Hypertension
* ASO titer
* Decrease glomerular filtration
* Swelling
* Tea color urine or cola colored
* Recent strep.
* Elevate BUN and creatinine
* Proteinuria
136
What are the 6 s/s of nephritis?
pallor, headache, irritability, lethargy, abdominal discomfort, loss of appetite
137
What is the diet for nephritis (2)?
low sodium
| low protein
138
What are the s/s of an infant with UTI (2)?
- poor feeder
| - smelly urine
139
What is the s/s of an older child with UTI have?
Might not want to go to the bathroom because of the pain
140
What would be educated to patients with UTI (5)?
* No tub baths or harsh soaps
* Wipe front to back
* Hydration
* Constipation prevention
* Sexual activity prevention strategies (urinate before and after sex)
141
What is Vesicoureteral Reflux?
flow of urine goes teh wrong way
142
What are the 3 treatments to Vesicoureteral Reflux?
• 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
If a pregnant patient has syphilis, what birth defects can it cause (3)?
IUGR
Preterm
Stillbirth
144
How would you treat someone with syphilis?
* PCN IM if less than one year old
| * IF more than one year, give PCN once a week for 3 weeks
145
How to treat syphilis if allergic to PCN?
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
What are the 4 s/s of chlamydia?
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
What is the treatment for chlamydia (4)?
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
What is gonorrhea?
* 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
What are the 7 s/s of gonorrhea?
```
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
What are the 3 treatments for gonorrhea?
* Ceftriaxone 200mg IM and 1-gram Zithromax (chlamydia usually occurs with gonorrhea)
* All partners need to be treated
* Newborns treated with erythromycin (ointment)
151
What are the risk factors for group B streptococcus (7)?
```
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
When should the mother be screened for group b strep?
• 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
What is the treatment for GBS?
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
If mom has GBS and allergic to PCN, what is the treatment?
• 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
What is Bacterial Vaginosis?
- 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
How does Bacterial Vaginosis affect pregnancy (2)?
PROM or Preterm birth
157
How is Bacterial Vaginosis treated?
Metronidazole (oral or vaginal cream) or clindamycin can be used
158
What would you teach someone with Bacterial Vaginosis (3)?
-avoid intercourse, use condom, wash hands
159
How do you treat UTI (4)?
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
What is Metritis (endometritis and Parametritis)
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
What causes endometritis (5)?
* Trauma
* Staples
* Multiple vaginal exams
* Premature rupture
* Any invasive procedures
162
What causes parametritis?
-Caused by blood clot in pelvic vein that can be infected and necrotic
163
What does REEDA stand for?
Examine redness, edema, ecchymosis, discharge, wound approximation
*for parametritis
164
What s/s are found in metritis (8)?
* Chills and fever
* Decrease in appetite
* Headache/ backache
* Prolonged afterpains
* Tender/ large uterus
* Foul odor
* Ileus
* Elevated EBC (exhaled breath condensation -pH values)
165
What is mastitis?
inflammation of the breast
166
What educational teachings should be done to patients with mastitis?
* Wear loose clothes
* Don’t miss any feedings
* Wash hands
* Rest
167
What are the 5 signs and symptoms of fungal mastitis?
nipple pain, stabbing pain between feedings, milk may smell yeasty, infected breast becomes pink shiny, pruritic and flaky
168
How do you treat mastitis (6)?
NSAIDS, warm moist compress or ice, increase in fluid intake, penicillin or Keflex
169
What medication should be given to the baby and mother if mom has mastitis?
Candida infection: oral Nystatin for the baby and antifungal cream or ointment for the mother (wash off and dry before breastfeeding)
170
What causes mastitis (5)?
- 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
Should the mother stop breastfeeding if she has mastitis?
No. continue feeding as normal
172
How can you get Hepatitis A?
Route: fecal, oral
| -sharing needles
173
How can you get Hepatitis B?
-route: bloodborne pathogen transmitted primarily through sex or needles
174
When should the Hepatitis B vaccine be given?
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
What is the difference between Herpes type 1 and herpes type 2?
- Type one presents as a cold sore that can be transmitted through kissing
- type 2 can be from genital herpes
176
What are the similarities between type one and two herpes (8)?
• 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
What are venereal warts?
STI caused by HPV type 6 and 11
| -Cauliflower like lesions on the penis or vagina
178
What is one treatment used to treat Venereal warts? What are two treatments that act as a teratogen? what is used to remove lesions?
• 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
What treatments can be given for HIV (3)?
Hep-B vaccine, pneumococcal vaccine and flu shot should be given
180
What should be avoided if you have HIV?
-avoid invasive procedures. At risk for hemorrhage and poor wound healing
181
What is candidiasis?
yeast infection
182
What are 5 factors can lead to candidiasis?
```
Pregnancy
Diabetes
Immunosuppressants
Antibiotic use
Douching
```
183
What should you educate a patient with candidiasis (3)?
• Educate patient to wear cotton underwear, avoid powders, and add yogurt and probiotics to replenish flora
184
How do you treat candidiasis when thrush shows up?
o Treat: nystatin rinse/ swallow
185
What is used to treat candidiasis (4)?
o Treated with clotrimazole cream or miconazole cream/ suppository, tioconazole ointment
o Weak solution of sodium bicarbonate may give pain relief
186
What is trichomonas? What happens if it is untreated?
a protozoan STI that shows as a yell-greenish frothy smelly discharge
-Untreated, can cause PROM, preterm birth and low birth weight
187
What should you avoid if you have trichomonas?
avoid alcohol and sex
188
What is toxoplasmosis? What happens if it is untreated?
a protozoan that is NOT an STI
- obtain it from undercooked/ raw meat or from cat feces
- untreated can lead to fetal death
189
What are the three treatments used to treat toxoplasmosis?
-pyrimethamine (antiparasitic med.), sulfadiazine (antibiotic), folinic acid (reduce toxicity effects of pyimethamine)
190
What does the TORCH acronym mean?
```
Describes infections that cause harm during pregnancy
Toxoplasmosis
Other: (syphilis, hepatitis, HIV)
Rubella
Cytomegalovirus
Herpes Simplex
```
191
What is thrombophlebitis?
• Blood clot in response to inflammation in a vein wall (can be deep or superficial)
192
What is Virchow's triad?
factors that lead to thrombosis: vessel wall injury, hyper coagulation of blood, stasis of blood
193
If you have a mental illness and are breastfeeding, what medication is okay to take?
SSRI (Zoloft)
194
When breastfeeding what do you need to watch out for when taking benzos?
if the fetus has withdrawal symptoms
195
Can you be on medication if you want to breastfeed and you have schizophrneia?
• 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
What is the difference between postpartum blues and postpartum depression?
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
What is postpartum psychosis?
* 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
What drug can cause premature rupture of the amniotic sac?
cocaine
199
What are 6 s/s of neonatal withdrawal?
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
What is neonatal abstinence syndrome?
a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother's womb
201
What CNS s/s would you see in NAS (7)?
```
o Sleep pattern disturbance
o Hyperactivity
o Tremors
o Increase muscle tone
o Myoclonic jerks
o Shrill cry
o convulsion
```
202
What Respiratory s/s would you see in NAS(4)?
o nasal flaring
o sneezing
o tachypnea
o hiccups, yawning
203
What GI s/s would you see in NAS (4)?
o Vomiting (make sure to elevate head to prevent aspiration)
o Diarrhea
o Poor feeding
o Excessive sucking
204
What metabolic s/s would you see in NAS (6)?
```
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
How much alcohol is safe to consume while pregnant?
No amount of alcohol
206
What can drinking alcohol cause in the infant?
leading known cause of mental retardation
207
What s/s are related to FAS(6) (what do they look like)?
o s/s: underdeveloped jaw, small head, low nasal bridge, small eye opening, short nose, poor impulse control
208
How would you treat neonate with FAS (3)?
-swaddle, reduce stimuli, supportive measures
209
What should the nurse educate the patient on who has FAS regarding breastfeeding (7)?
```
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
What are the 9 factors that may lead to an episiotomy?
- primigravida
- shoulder dystocia
- macrosomia
- vaccuum
- forceps
- occiput-posterior position (baby comes out butt first)
- lithotomy
- breathing
- limit the second stage of pregnancy
211
What 6 interventions can be taken to mitigate episiotomy?
- perineal massage
- natural pushing
- push and breathe slowly
- avoid pushing immediately after epidural placement
- warm compression
- side-lying
