Unit 3 exam Flashcards
infants of diabetic mothers r/o
- congenital anomalies
- cardiac anomalies
- IUGR
- respiratory distress
neonate hypoglycemia onset
•BS < 40 in term •BS < 25 in preterm •jittery •RDS •lethargy •poor suck •seizures *w/in 1-3 hrs after birth
polycythemia
- Hct > 65%
- inc. blood viscosity -> poor O2
- inc. RBC hemolysis -> jaundice
- inc. r/o cephalhematoma/bruising
early onset neonate bacterial infection
- congenital
- rapid progression (1-2 days)
- hypothermia common s/sx
- GBS most common
late onset neonate bacterial infection
- acquired
* late progression (1-2 wk)
drug/etoh neonate effects
- pre-term
- placental abruption
- LBW
- small head
- high pitched cry
- IUGR/UPI
- exaggerated reflexes
pathologic jaundice
•appears w/in first 24 hrs •r/t excessive RBC destruction -blood incompatibility •bill high and stay high *get stat bill if suspected
physiologic jaundice
- appears after first 24 hrs
- benign
- resolves by day 4
omphalocele
•intestines stick out of umbilicus are COVERED by thin layer of tissue
gastroschisis
•intestines stick out of umbilicus UNCOVERED
when is suck-swallow-breath reflex mature
•34 wks
readiness to PO feed
- rooting
- sucking
- gag
- RR < 60
- tolerate being held
preterm expected UOP
•1-3 mL/kg/hr
assessing preterm renal fxn
- UOP
- Na, hct, BUN, SG
- weight
- turgor/edema
- anterior fontanelle
preterm hematologic issues
- inc. cap friability
- inc. clotting time
- dec. erythropoiesis
- dec. RBC life
- dec. blood vol.
bronchopulmonary dysplasia
•O2 still required 28 hrs after birth or 36 wks post conceptual age
necrotizing enterocolitis (NEC)
•accumulation of gas in submucosal layers of bowel wall
•causes necrosis, perforation, and sepsis
•abd. distension, bloody stool, feed retention
*2 wks after birth
post-mature characteristics
- old placenta -> dec. O2/nutrients
- meconium aspiration
- polycythemia
- hairy
- long nails
- dry, peeling skin
small for gestational age (SGA)
•< 5.5 lbs in term
asymmetric growth restriction
•head and length unaffected
•weight disproportional
•recover w/ nourishment
*r/t MID PG complications
symmetric growth restriction
•weight, length, head all affected
•may have long-term growth issues
*r/t EARLY PG complications
NIPS
•neonatal infant pain scale
- facial expression
- crying
- arm movement
- leg movement
- state of arousal
- hormone levels
CRIES
•neonatal pain scale Crying Requires oxygen Increased VS Expression Sleepless
diagnostic testing
•evaluates for and tells of there IS a genetic/congenital issue
screening
•evaluates RISK FOR an issue
antepartum testing
- evaluates fetus AFTER problem is detected
* Ex: NST, kicks, U/S
1st trimester U/S
•TV or TA •dates (CRL) •# fetus •heart activity *1-12
2nd trimester U/S
•TA •fetal anatomy/viability •sex @ 18 wk •PTL assessment *13-27
3rd trimester U/S
•fetal well being •BPP •AFI •placental location/grading •growth (IUGR) •presentation •PTL assessment *28-birth
nuchal translucency
- 1st tri screening done 10.5-13.5 wks
- assessing for downs
- contra: pt refuse; past dates
quad screen
- MSAFP
- hCG
- Estriol
- Inhibin A
maternal serum feroprotein screening (MSAFP)
•2nd tri screening done 16-20 wks •high = ONTD •low = downs *requires followup (don't repeat) *false + if multiple gest, dates off
amniocentesis in 2nd tri
- after 14 wk
* detects karyotype
amniocentesis in late 3rd tri
- detects fetal lung maturity (2:1)
* detects Rh incompatibilities
amniocentesis risks
- SAB
- stillbirth
- ROM
- PTL
- abruption
- fetal injury
chronic villus sampling
- 1st tri alternative to amniocentesis
- test fetal portion of placenta
- genetic testing @ 10-12 wks
- r/o SAB/limb loss
percutaneous umbilical blood sampling (PUBS)
•18 wks = genetics
•3rd tri= blood tranfusion for hemolytic dz
•r/o cord lac/hematoma/ROM/PTL/infection
*often in OR b/c may have to get baby out ASAP
reactive NST
•< 32 wk = 10x10
•> 32 wk= 15x15
•mod. variation and NO decals
*indicates CNS fxn
non reactive NST
•minimal variation •no accels •+ decels •requires CST or BPP *may have to induce
CST
- induction of ctx to assess FHR in response to stress
- more invasive (IV) than NST and BPP
- contra in preterm and anything that would lead to PTL
negative CST
•no decels
•3 ctx in 10 min
•reassurance that fetus will survive labor
*normal
postive CST
•late decels in > 50% ctx
•indicates UPI
•requires induction or C/S ASAP
*abnormal
biophysical profile (BPP)
•U/S and EFM to assess
- FHT
- breathing
- amnio vol.
- movement
normal BPP scorring
•8/8 = normal (didn’t do NST)
•8/10 = normal and non-reactive NST
•10/10 = normal and reactive NST
*no evidence of UPI
equivocal BPP
- 6
* repeat in 24 hr
abnormal BPP
- < 6
* induce/C-section ASAP
polyhydramnios
•AFI > 25 •d/t -NTD -GI obstruction -twins -hydrops -DM -congenital anomalies
risks r/t polyhydramnios
- cord prolapse
- PROM
- unsuccessful labor
oligohyramnios
•AFI < 5 •d/t -renal issue -PROM -post-dates -UPI
risks r/t oligohyramnios
- cord accident
- fetal malformation
- hypoplastic lungs
fetal kick count instructions
- eat/relax
- should feel 10 movements in 2 hrs
- if no move in 12 hrs -> further testing
PTL clinical characteristics
- b/t 27-37 wks GA
- > 6 ctx/hr
- cervical change
- vag bleeding/discharge
PTL interventions
- prevention/early detection key
- tocolytic
- steroids
- bed/pelvic rest
tocolytic drugs
•MgSO4 •terbutaline •nifedipine •indomethacin *promote uterine relaxation
low birth weight (LBW)
- ANY baby born < 2500 g, regardless of GA
* usually caused by IUGR
PROM
•premature rupture of membrane 1+ hr before onset of labor
PPROM
•premature rupture of membrane 1+ hr before onset of labor AND GA < 37 wks
risks r/t PPROM and PROM
- infection
- cord prolapse
- fetal abnormalities (skeletal; lung)
s/sx cord prolapse
•severe variable decels
•fetal bradycardia
•see cord
*ALWAYS vag exam if suspected
hypotonic labor vs. hypertonic labor
•hypo is no fetal distress
•hypo may require augmentation
•hyper may require uterine resuscitation
*both involve NO cervical change
causes of passageway (tissue) obstruction
•full bladder (#1)
•cervical edema
•HPV
*avoided by emptying bladder and not pushing until 10 cm
shoulder dystocia interventions
- McRoberts- knees to chest
- Gaskin- all 4s
- Zavanelli- push head in & C/S
uterine rupture vs. uterine dehiscence
- dehiscence is incomplete rupture w/ no pain or fetal distress
- rupture is complete and requires resuscitation & C/S
uterine resuscitation
- pt on side
- stop pit
- open main fld. line
- O2 @ 10L
- vag exam (r/o prolapse)
- Brethine (uterine rlx)
tachysystole
•hyper stimulation of uterus
•ctx > 90 sec
•> 5 ctx in 10 min
*causes late decel; loss of variability
when uterine resuscitation may be necessary
- tachysystole
- uterine rupture
- hypertonic ctx
pitocin admin
- ALWAYS IVPB on pump
- attach close to insertion site
- start low and slow
Bishop score
•estimates how successfully labor can be induced •based on: -dilation -effacement -station -consistency -position
readiness for induction
•Bishop of 9+ for nulls
•Bishop of 5+ for multip
*if not ready (low score) may have to cervical ripen
amniotomy
•AROM
•fetal station MUST be low
*WONT shorten labor
excessive fld following amniotomy indicates…
- polyhydramnios
* high fetal station (DONT ambulate)
important after episiotomy
•NEVER give enema/suppository
*do give PO stool softeners
fibrocystic changes
- benign breast d/o
- bilateral pain/tenderness
- occurs prior to menopause
- tx: diuretics; NSAIDs; no caffeine; reduce Na+
tamoxifen
- selective estrogen receptor modulator (SERM)
- breast cancer hormone adjuvant
- blocks estrogen
- ONLY works on estrogen-receptive tumors
- SE similar to menopause
candidiasis
- vaginal yeast infection
- white, thick, curdy d/c
- no odor
- itching
bacterial vaginosis
- thin, gray/white or yellow/green d/c
- malodorous
- profuse
gonorrhea
•green d/c
•dyspareunia; dysuria
*r/o PROM
chlamydia
- yellow d/c
- asymptomatic in women
- no abx tx -> PID
trichomoniasis
•thin green/yellow d/c •malodorous •itching, redness, edema •looks like sperm *both partners need abx and refrain from sex
syphilis
- painless chancre (male ID)
- primary, secondary, tertiary
- PCN ONLY tx
herpes
- blisters
- severe vulvular pain; dyspareunia
- no cure
toxic shock syndrome
- caused by staph
- leads to hypovolemia, hypotension, shock
- s/sx: flu-like, hypotension, rash
best indicator of endometrial cancer
•bleeding after menopause
•hypertensive
*most common malignancy of reproductive system
primary amenorrhea
- menarche after 16
- menarche 1 yr later than mom
- menarche same age as sister
secondary amenorrhea
- absence of 3 menstruation cycles after regular established
* most common cause is PG
primary vs. secondary dysmenorrhea
- primary has unkind cause
- secondary d/t dz (fibroids, endometriosis, PID)
- tx: OCPs; NSAIDs
endometriosis
•endometrial cells grow outside of uterus
•often leads to infertility b/c of tube/ovary occlusion
•laparoscopic dx
•no tx necessary if no pain or PG desire
•surgery if s/sx severe
*hyoestrogenism bone loss r/t med tx reversible after stop med
basal body temp and ovulation
- decreases right before
- increases during
- stays high if PG
physical changes of menopause
•cessation of estrogen/progesterone -dry -hot flashes -insomnia •bladder, vag, urethra atrophy
diaphragm
•6 hrs before sex
•leave in 6-8 hrs
•refit q2-3yr or if 10 lb change
*r/o toxic shock
cervical cap
•30 min before sex
•leave in 6-8 after
*r/o toxic shock
spermicide
- 15-30 min before sex
* reapply q1h or each encounter
female condom
•8 hrs before sex
PAINS
•IUD warning signs Period late/abnormal Abd pain Infection Not feeling well String length change
combined oral contraceptive (COC) fxn
- suppress ovulation
- thicken cervical mucous
- effect endometrial lining
ACHES
•COC AE (call MD) Abd pain Chest pain; cough HA; dizzy Eye problems Severe leg pain *don't stop pill abruptly
progestin-only pill (mini pill)
- changes endometrium and cervical mucous
- best if lactating or > 40 y/o
- MUST take @ same time
most likely spot to have atypical cervical (cancer) cells
- transformation zone
* where changes from cervical cells to endocervical cells
Peau de’ orange
•abnormal breast tissue texture that indicates inflammatory breast cancer
when is COC contraindicated
- > 35 AND smoke, HTN, migraine
* hx of thrombolytic complication
induction via oxytocin contraindicated if…
- late decelerations
* positive CST b/c ctx put fetus in distress
health risks associated w/ menopause
- osteoporosis
- obesity
- heart dz
when are PMS s/sx present
- week before menstruation
* resolve w/in couple day of menses onset
what test helps dx IUGR
•doppler blood flow
possible neonate condition d/t steroid admin in utero…
•hypoglycemia
MgSO4 classification
•CNS depressant
*neonate r/o resp. suppression
normal respiration findings of preterm
•5-10 sec of respiratory pauses followed by 10-15 sec of rapid compensatory respirations
RN intervention shoulder dystocia
•suprapubic pressure
RN interventions for FHR decels and hypertonic ctx
- turn pt on side FIRST
* discontinue oxytocin
first intervention if pt reports no fetal movement
•auscultate for FHR
