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Nursing Semester 2 > Toni - Week 5 - Exam 3 > Flashcards

Toni - Week 5 - Exam 3 Flashcards

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1
Q

what is Group B Streptococcus?

A

a bacteria that can become colonized in women - no problem for women, but can be deadly for a newborn

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2
Q

what percentage of woman are colonized with GBS?

A

25% of pregnant women

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3
Q

for newborns, GBS is the leading cause of ____ and _____.

A

sepsis and deathj

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4
Q

how and when is Group B Streptococcus screened?

A

GBS is screened via swab/culture of a woman’s rectum and vagina at 35 to 37 weeks gestation

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5
Q

what is done if a woman tests GBS+??

A

She is given IV antibiotics during labor

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6
Q

If a woman is GBS+ and planned for a C-S, is antibiotics given to treat the GBS??

A

depends, are the membranes intact or not? if intact, it’s okay; prophylactic antibiotics given during C-S

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7
Q

what two antibiotics are given for GBS?

A
  • penicillin G: 5 million units initial dose, then 2.5 million units q4hr until delivery
  • ampicillin: 2 g initial dose, then 1 g q4hr until delivery
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8
Q

what occurs if a mother is GBS+, in labor, not yet screened, and not yet given antibiotics?

A

there is rapid GBS screen; we will try go wait labor until baby has had an adequate dose of 4 hrs

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9
Q

what occurs when a baby has not been given an adequate dose for GBS antibiotics?

A

If baby born within 1/2/3hr - not given adequate tx - tell MD - further watching

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10
Q

what is cervical insufficiency?

A

premature dilation of cervix WITHOUT contractions - (efface/change of the cervix)

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11
Q

what are the risk factors of cervical insufficiency?

A

short cervix, cervical trauma, and possibly an abortion that manipulated the cervix (the integrity of cervix is lacking in order to stay closed)

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12
Q

what are the 4 ways that cervical insufficiency be managed?

A

bedrest, fluids, possible tocolysis (meds to stop contraction), and cerclage

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13
Q

cerclage: what is it?

A

circle stitch around cervix to reinforce CLOSED cervix **can’t tighten up, needs to be closed

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14
Q

cerclage: when is it placed?

A

surgically placed 12 - 14 weeks gestation

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15
Q

cerclage: what are activity restrictions?

A 
pelvic rest (no tampons, no sex, minimal vaginal exam)
possible bedrest
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16
Q

what is hyperemesis gravidarum?

A

pernicious (dangerous) vomiting first 20 weeks - beyond morning sickness

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17
Q

what is hyperemesis gravidarum associated with?

A

significant dehydration and weight loss **hard on mother and developing fetus

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18
Q

what are the 7 interventions for hyperemesis gravidarum?

A
  • IV fluids with glucose, electrolytes, vitamins (NS, D5W, Banana Bag)
  • Antiemetics
  • Sea-bands (accupressure), ginger, herbal tea
  • TPN, small frequent meals (crackers)
  • Avoid laying down 2 hrs after eating
  • Home: carbonated drinks, high protein drinks
  • Monitor fetal growth via serial ultrasounds
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19
Q

what is placenta previa?

A

placenta implanted near or over cervix

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20
Q

what are the signs and symptoms of placenta previa?

A

painless bleeding after 20th week without uterine contractions

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21
Q

what are the risk factors of placenta previa?

A

history of C/S, ↑ maternal age/parity, smoking

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22
Q

what are the three different types of placenta previa?

A

marginal, complete, low lying

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23
Q

what are the management steps for placenta previa?

A
  • ultrasound, type/Rh/cross, CBC (H+H)
  • IV, external fetal monitoring, bedrest, pelvic rest, no straining for BM (stool softener, nutritiono)
  • no vaginal exams, assess blood loss (dislodged placenta)
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24
Q

placenta previa: what types are possible for a vaginal birth?

A

low lying or marginal previa

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25
Q

placenta previa: what types are only for C/S?

A

marginal or complete previa

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26
Q

women with placenta previa are at an increased risk of what?

A

increased risk of infection (healing site is closer to the entrance)
increased risk of hemorrhage (don’t have same tough fibers)

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27
Q

what is abruptio placentae?

A

premature separation of placenta after 20th week

  • partial or complete
  • bleeding can be revealed or concealed
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28
Q

what are the s/sx of abruptio placentae?

A

painful, board-like abdomen (constant contraction), vaginal bleeding, uterine irritability, fetal distress, late decelerations

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29
Q

what are the risk factors of abruptio placentae?

A

abdomen trauma, HTN, somking, cocaine/alcohol use, car accident, domestic violence

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30
Q

how can abruptio placentae be managed?

A
  • CT scan, bedrest, external fetal monitoring, IV, type/Rh/cross, CBC (H+H)
  • Assess blood loss (use 18 gauge for blood transfusion) to prevent hemolysis)
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31
Q

T/F there is a risk of depleting clotting factors and disseminated intravascular coagulopathy with abruptio placentae

A

TRUE; this is clotting and bleeding at the same time

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32
Q

with abruptio placentae, fetal outcome depends on ___________ and _________.

A

the degree of separation and gestation

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33
Q

when does preeclampsia occur?

A

occurs after 20 wk.↑ incidence delayed postpartum onset - **reason we check DTR

34
Q

Preeclampsia is the _____________

A

2nd leading cause of pregnancy related death

35
Q

who is at risk for preeclampsia?

A

primigravida, > age 40, history of preeclampsia, obesity

36
Q

Etiology for preeclampsia has ______________.

A

not been determined

37
Q

what is the pathophysiology of preelampsia? *the disordered physiological processes associated with disease or injury.

A
  • endothelial injury
  • vasoconstriction
  • CNS changes
  • decreased renal perfusion
  • hepatic malfunction
38
Q

what are the adverse effects of preeclampsia in relation to the baby?

A
  • intrauterine growth retardation (↓ perfusion)
  • prematurity
  • death
39
Q

what are the adverse effects of preeclampsia in relation to the mother?

A
  • abruption
  • kidney damage
  • liver infarction/rupture
  • stroke
  • intracranial bleed
  • retinal detachment
  • pulmonary edema
  • death
40
Q

what is eclampsia??

A

onset of seizures in preelamptic women

41
Q

how is preeclampsia defined as far as diagnostics?

A

defined as the presence of

  • hypertension: BP >/= 140/90 on 2 occasions at least 6 hrs apart
  • proteinuria: > 300mg/L total protein in 24 hr urine
42
Q

what are some other s/sx of preeclampsia?

A

edema (face/hands), weight gain, oliguria, ↑ renal labs, severe HA, tinnitus, visual disturbances, hyperreflexia, epigastric pain

43
Q

what is HELLP syndrome?

A

a severe form of preeclampsia

44
Q

What does HELLP stand for?

A
  • Hemolysis: ↓ H+H ↑ bilirubin
  • Elevated Liver enzymes: ↑ AST + ALT
  • Low Platelet count: < 100,000 mm3 (brusing, bleeding)
45
Q

what is the complications of HELLP?

A

disseminated intravascular coagulopathy, and same complications of preeclampsia

46
Q

what is the mortality rates of HELLP?

A

24% maternal

30% fetal

47
Q

what are interventions for preeclampsia? nursing care

A
  • bedrest lateral position (placenta perfusion), calm environment, padded side rails
  • high protein diet
  • foley - strict I + O
48
Q

what are interventions for preeclampsia? labs/assessment

A
  • monitor proteinuria, CBC, liver/kidney function, clotting

- Assessment: BP, daily weight, headache, edema, DTRs, clonus, visual disturbances, epigastric pain

49
Q

what is management for preeclampsia?

A
  • betamethasone (promotes fetal lung maturity)
  • antihypertensive drugs
  • magnesium sulfate IV (doesn’t control HTN)
  • delivery
50
Q

how and why is magnesium sulfate given?

A

Administered IV to prevent seizures (not to ↓ BP)

51
Q

what are common side effects of magnesium sulfate?

A

warmth, flushing, muscle weakness; “heavy” feeling

52
Q

what is the therapeutic level of magnesium sulfate?

A

monitor serum magnesium levels; therapeutic: 4 - 8 mg/dL

53
Q

we should monitor for magnesium toxicity. what s/sx should we be looking for?

A
  • oliguria
  • depressed/absent DTRs
  • respirations < 12
54
Q

what is the anecdote for magnesium sulfate?

A

calcium gluconate

55
Q

what are the adverse effects of magnesium sulfate?

A

↑ risk of postpartum hemorrhage (relaxes smooth muscle)

newborn CNS depression

56
Q

what does maternal insulin resistance during pregnancy produce?

A
  • ↑ blood glucose for fetal growth
  • ↑ insulin demand on maternal pancreas
  • maternal hyperglycemia if insulin inadequate
57
Q

at birth, what occurs in relation to insulin?

A

abrupt change in hormones immediately increases maternal insulin sensitivity
- insulin dependent diabetic women will experience dramatic drop in need for exogenous insulin (24-48hr)

58
Q

what is the rupture of amniotic membranes?

A

premature rupture of membranes (PROM)

59
Q

what is it called when the rupture of membranes occurs before 37 weeks?

A

premature premature rupture of membranes (PPROM)

60
Q

Risk of ________ increases with the length of rupture

A

infection

61
Q

how is PROM diagnosed?

A

diagnosed via

  • visualizing pool of fluid via sterile speculum exam (+ pooling)
  • fernlike pattern of dried fluid under microscope (+ ferning)
  • nitrazine paper turns blue - assuming not bleeding
  • PAMG test (amni-sure) via swab
62
Q

what are we monitoring during PROM

A
  • fetal well being
  • maternal VS (temp q 2hr)
  • WBC, CRP
63
Q

what are interventions taken for PROM?

A

administer antibiotics as ordered

pelvic rest, no vaginal exams

64
Q

when would we like to see a woman go into labor after PROM?

A

within 12hr; at 18hr, we will start antibiotics

65
Q

what is gestational diabetes mellitus (GDM)?

A

glucose intolerance onset during pregnancy

66
Q

does GDM subside?

A

yes, usually subsides after delivery

67
Q

when will the woman be evaluated for intolerance postpartum?

A

evaluated 6 weeks postpartum for continued glucose intolerance

68
Q

how many women will develop DM type 2 if they had GDM?

A

1/3 will develop DM type 2 in their lifetime

69
Q

what do we assess for GDM?

A
  • 1 hour GTT 24-28 weeks
  • If > 140; will have 3hr GTT (GDM diagnosed if one or more these values elevated)
  • Hemoglobin A1C test: measures long term glucose control past 120 days
    < 7% indicates good control
70
Q

what can we do to manage diabetes during pregnancy?

A

very tight blood sugar control (fasting < 92mg/dL)
teach nutrition and weight management
encourage regular mild exercise
instruct in blood glucose and urine ketone testing

71
Q

what meds can be given to manage diabetes in pregnancy?

A

insulin (dosages ↑ as pregnancy progresses)

oral antidiabetic agents may be prescribed

72
Q

diabetic management: how are we monitoring the fetus?

A

maternal serum alpha fetoprotein, kick counts, non-stress test, biophysical profile, ultrasound, and amniocentesis

73
Q

diabetic management: when is a mom a candidate for induction?

A

38 weeks

74
Q

What is recommended for HIV+ women?

A

oral anti-HIV meds reccomended during pregnancy and labor

75
Q

what will further reduce neonatal transmission rate and what are the rates?

A

IV zidovudine (AZT)
< 7 % transmission vaginal
< 1% transmission C/S

76
Q

how can we protect the fetus from maternal secretions during labor?>

A
  • leave amniotic membranes intact
  • avoid inserting FSE, or IUPC (breaks skin)
  • avoid forceps/vacuum extraction (trauma)
77
Q

what does ATOD mean?

A

use of alcohol, tobacco, and other drugs; including non-medical use of prescription meds

78
Q

why are we considered about ATOD?

A

because all pass readily through placenta to the fetus

79
Q

what is the highest ATOD use in SLO county?

A
  • alcohol
  • tobacco
  • opiates
80
Q

what is our role as nurses in regards to ATOD?

A
  • offer empathy/establish trust
  • assess substance use (self report, urine toxicology screen)
  • teach negative effects, importance of nutrition, and s/sx of preterm labor and placental abruption
  • support efforts to change
  • refer to counseling/support
81
Q

what are the 4 Ps to asking about substance use?

A
  • did your PARENTS have a problem with drugs + alcohol?
  • does your PARTNER have a problem with D + A?
  • have you ever in your PAST drank alcohol/smoke tobacco?
  • in the month before you learned you were pregnant, did you drink alcohol or smoke?

Nursing Semester 2 (21 decks)

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