Exam 3 Flashcards
(112 cards)
1
Q
Signs of placental separation:
A
○ Change in uterus shape from discoid to globular (as moves down and contracts)
○ Sudden gush of blood
○ Lengthening of umbilical cord
○ Palpation of tissue in the vagina
2
Q
Nursing Interventions for Newborn(First Two Hours Recovery)
A
○ Newborn assessment q30 (fundal assessment and vital signs)
○ Administer erythromycin/vitamin K (eyes/thighs or E/T)
○ Assist with breastfeeding
○ Apgar scoring, weigh, measurements, security bands, education
○ Assist with bonding and feeding initiation
3
Q
Nursing Interventions for Patient: (First Two Hours Recovery)
A
○ Start postpartum Pitocin (Oxytocin)
○ Maternal assessments q15 for 1st hour then q30 for 2nd hour (fundal
assessment and vital signs)
○ Pericare, pain medication, comfort measures, assist to bathroom,
education
4
Q
2-12 hours Postpartum General Protocols: Post-Vaginal Birth
A
b
● VS and fundal checks q8-12
● Motrin and Tylenol● If epidural, as soon as wears of
●If no epidural, up to bathroom & ambulating right away
●If epidural, as soon as wears off
○May have urinary retention upon first void
●VS and fundal checks q8-12
●Motrin and Tylenol
○ May have urinary retention upon
first void
● VS and fundal checks q8-12
● Motrin and Tylenol
○ May have urinary retention upon
first void
● VS and fundal checks q8-12
● Motrin and Tylenol
5
Q
Post-Cesarean Birth:
A
●Bedrest for ~12 hours●Foley catheter●IV fluids infusing●VS and fundal checks q4●Motrin/Toradol and/or PO narcotic
6
Q
Uterus Assessment: Subinvolution Definition
A
●a disruption in the normal involution process
○Immediate or delayed; can cause a postpartum hemorrhage or occur due to retained placenta
7
Q
Why does patient position matter when the RN is completing a fundal massage?
A
More accurate: as umbilical will be in a different location. Place patient supine
8
Q
Fundal assessment documentation
A
○Firm (contracted) or boggy (soft, not contracted)
■Referring to the top of the fundus
○Midline (anatomically corrected) or deviated (pushed to the side) (means bladder is too full)
■Referring to the location of the uterus in the pelvis
○Scant, light, moderate, heavy lochia with or without clots
■Documented of fundus in relation to umbilicus
■Expected to be at the umbilicus day 0 postpartum and move at least 1 fingerbreadth below the umbilicus each day postpartum
■Examples: documented as 1↑U or 2↓U
●Measured in fingerbreadths (FB) above or below the umbilicus
■Concern if the fundus is increasing above umbilicus rather than decreasing below the umbilicus postpartum
9
Q
BUBBLELE: Bladder
A
●Significant diuresis in the days following birth
●“Due to void” (DTV) within 4-6 hours after catheterization/most recent void
●Urinary retention is possible
○Increased risk if had epidural anesthesia or cesarean birth
●Burning with urination can occur if laceration/episiotomy
●Risk of UTI remains increased postpartum
○Further increased risk if had a catheter during hospitalization
10
Q
BUBBLELE: Bowel
A
●May take up to 3 days before the first bowel movement postpartum
- ○First 3 days: encourage ambulation, fluids, increase fiber-rich foods, stool softener*
- ○3+ days without a bowel movement: discuss with provider alternatives; consider laxative in PO or suppository form and/or enemas*
●Assess presence of flatus: gas
●Post-op cesarean patients can experience trapped gas
○Important to encourage clear liquids first before a large meal postpartum
●Hemorrhoids may have been present in pregnancy
○Often aggravated with pushing in a vaginal delivery
11
Q
BUBBLELE: Lochia
A
●Cervical os slowly closes postpartum
●Passing of menstrual-like blood until ~6 weeks postpartum
●Bleeding should slow and follow this pattern. If does not, could be a sign of a complication
- ○Lochia rubra: Days 1-3, bright red, small clots*
- ○Lochia serosa: Days 4-10, brown/pink*
- ○Lochia alba: Day 10+, yellow/white*
●Color and consistency of blood gives insight into origin
12
Q
BUBBLELE: Episiotomy/Lacerations/Incision
A
●REEDA is an important acronym when assessing wounds
●Redness
●Eccyhmosis (bruising)
●Edema
●Drainage
●Approximation○Any signs of dehiscence? (separation of wound)
●Assess lacerations from vaginal delivery and post-op incision scar○All sutures usually dissolvable; cesarean incision may have staples
13
Q
Perineal Lacerations Degrees
A
●1st-4th degree, ranging from most superficial to deepest
1st degree: through perineal skin only
2nd degree: through perineal muscles
3rd degree: through the anal sphincter muscle
4th degree: through the anal sphincter and rectal mucosa
14
Q
BUBBLELE: Legs
A
●Postpartum patients still at high risk for DVTs and now sometimes immobile post-op or not ambulating a lot due to recovery and time spent with newborn
●Assess for edema, varicosities, thrombophlebitis, DVT
●Assess for deep tendon reflexes and clonus if patient is preeclamptic
●Ensure SCD boots applied if patient is not ambulating
15
Q
BUBBLELE: Emotional Status:
A
Baby blues: ~80% of patients experience
■Transient feelings of sadness, bouts of crying, overwhelm
■Lasts about 1 week
16
Q
Rubin’s Model of Maternal Postpartum Adjustment:
A
●Taking in (dependent phase)○1st 24 hours○Focused on self and basic needs, excited, talkative, reviewing birth experience
●Taking hold (dependent/independent phase)○Lasts 10 days-several weeks○Focused on new role, optimal time for teaching and learning
●Letting go (interdependent phase)○New parent role is accepted, reestablishing relationship with partner, accepting of family unit
17
Q
Other Postpartum Physiologic Changes: Hormonal
A
Hormonal Changes:
●Dramatic decrease in estrogen and progesterone
●Lactational amenorrhea related to increase in prolactin and oxytocin with breastfeeding
18
Q
1st T: Tone (Uterine atony):
A
●Risk factors: full bladder, large uterus, high parity
●Assessment: boggy uterus; excessive bleeding
●Intervention: fundal massage, uterotonic medications
19
Q
2nd T: Tissue (Retained placenta)
A
●Risk factors: preterm delivery, placental abnormalities
●Assessment: boggy uterus; excessive bleeding
●Intervention: Assess for and remove retained products
20
Q
3rd T: Trauma (Lacerations, episiotomy, hematoma
A
●Risk factors: precipitous deliveries, OASIS, operative deliveries, macrosomia, abnormal presentation, labial varicosities
●Assessment: firm fundus, steady stream of bright red bleeding, bluish swelling near perineum; intense perineal/rectal pain/pressure
●Intervention: assess the site, hematoma evacuation
21
Q
4th T: Thrombin (Coagulopathy)
A
●Risk factors: coagulopathy, placental abruption, OB emergency
●Assessment: bleeding from IV sites/nose
●Intervention: treat underlying cause, transfusions
22
Q
Uterotonic Medication: (know route/and generic name)
A
●Oxytocin (Pitocin) IV
○Double rate of normal postpartum Oxytocin
●Misoprostol (Cytotec) PR
○Can cause slight increase in temperature
●Hemabate (Carboprost) IM
○Can lead to diarrhea
○Contraindicated in patients with asthma●
Methergine (methylgonovine maleate) IM
○Contraindicated in patients with hypertension
*bold is generic
23
Q
Signs and Symptoms of Postpartum Infections:
A
fever, chills, tachycardia, foul-smelling or looking lochia or drainage, redness
*****If a fever spikes postpartum, we do not refer to it as chorioamnionitis anymore (only when pregnant) and instead endometritis
24
Q
Postpartum Discharge Teaching: WHEN TO CALL PROVIDER
A
●Fever > 100.4, pain/redness in leg, abnormal discharge/odor, sudden increase in lochia, preeclampsia signs and symptoms (headache, vision changes, nausea/vomiting, epigastric pain)
25
Postpartum DVT: Signs and Symptoms of Thrombophlebitis: Inflammation
●Signs and symptoms: redness, warmth, pain, tenderness, edema, fever
●Interventions: elevate, heat, pain meds, SCDs
●Can progress to superficial thrombophlebitis, DVT, pulmonary embolism (PE)
26
Postpartum DVT: Signs and Symptoms of _Thrombosis/DVT_: clot formed from inflammation or partial obstruction of a vessel
●Similar signs & symptoms as above
●Similar treatment with addition of strict bedrest and initiation of anticoagulant
27
Ideal Newborn Vital Signs
●Allow a transition period for vitals to regulate
●Heart rate: 120-160○Brief fluctuations above or below normal depending on sleep/active states
●Temperature: 97.7-99.5 F (36.5-37.5 C)
●Respirations: 30-60
28
MILD signs of Respiratory Distress
●Nasal flaring
●Grunting
●Retractions (use of intercostal or subcostal muscles “drawing in” of tissue between ribs)
29
MODERATE/SEVERE Respiratory Distress
●Suprasternal or subclavicular retractions with stridor or gasping
●Seesaw or paradoxical respirations
●Circumoral cyanosis (bluish of lips/mucous membranes)
●Central cyanosis○Late sign of distress indicating hypoxemia
●Apnea \> 30 seconds
30
First thing to do when you see Moderate/Severe Respiratory Distress?
ASSESS!!!
then…call for help.
31
**Transient Tachypnea of the Newborn (TTN)**
●Mild TTN occurs 1-2 hours post-birth●
Shows signs of respiratory distress
●May require supplemental oxygen
●Usually resolves within 24 hours
32
Newborn Thermogenesis:
○Newborns produce heat via nonshivering thermogenesis by metabolizing brown fat and increasing metabolic activity
○Newborns have small reserves of brown fat (the longer the gestation, the more brown fat)■This rapidly depletes with cold stress
33
Why are newborns more at risk for heat loss?
○Due to smaller surface area, blood vessels close to skin surface, little subcutaneous fat in newborns
34
Heat Loss: Convection
●_Convection_: flow of heat from body surface to surrounding cooler air○Example: naked baby in bassinet losing heat to cool air around them rather than being swaddled with a hat
35
Heat Loss: Conduction
●_Conduction_: flow of heat from body surface to a cooler surface in direct contact○Example: naked baby lying on a cold scale to be weighed without a blanket on it
36
Heat Loss: Evaporation
●_Evaporation_: flow of heat when liquid is converted to a vapor○Most significant cause of heat loss in the days after birth○Example: moisture vaporization from the newborn skin before dried after a bath
37
Heat Loss: Radiation
●_Radiation_: flow of heat from body surface to a cooler solid surface nearby (not directly touching)○Example: baby’s bassinet next to a window in the winter months rather than baby being far from window and any air drafts
38
Because of heat loss by convection: The ambient temperature in newborn care ares should range between what temperature and what humidity?
ambient temperature in newborn care areas should range between 22° and 26° C (72° to 78° F)
the humidity between 30% and 60%
39
Cold Stress Facts
●Increased physiologic and metabolic demands caused by hypothermia
●Symptoms: hypothermia, pale, mottled, cold skin●Can lead to and exacerbate hypoglycemia, hyperbilirubinemia, respiratory distress
●Avoid by minimizing heat loss and maintaining in neutral thermal environment
40
GI and Renal System Facts:
●Newborns have diuresis of excess extracellular fluid the first few days after birth○Contributes to expected weight loss \< 10% of body weight●
New research is emerging about the microbiome and health and relationship between birthing person and newborn’s microbiomes○Mode of birth affects microbial colonization of the newborn○Additional factors are antibiotic use, diet, and environment
41
Hepatic System Facts
●Immature at birth
●Liver functions: iron storage, glucose homeostasis, fatty acid metabolism, bilirubin synthesis, coagulation, drug metabolism
●Newborns have high concentrations of red blood cells (RBCs) at birth and these RBCs have shorter life spans → ↑ bilirubin which is a byproduct of RBC hemolysis → ↑ build-up of unconjugated bilirubin that must be broken down by liver
42
Jaundice:
●_Jaundice_: yellow discoloration of skin and sclera of eyes○Appears when total serum bilirubin \> 6-7 mg/dL○Risk factors: Born \<38 weeks, exclusive breastfeeding, prior baby with jaundice, significant bruising during delivery
## Footnote
Can be harder to assess visually in darker-skinned newborns
\*\*\*\*Jaundice usually starts in the head and progresses downward to the rest of the body
43
Bilirubin:
●_Bilirubin_: waste byproduct produced by RBC hemolysis○Two types: conjugated (easily excreted from the body) and unconjugated (insoluble and must be conjugated in liver to be excreted)
44
Hyperbillirubinemia is?
high bilirubin
45
_Acute bilirubin encephalopathy i_s?
●bilirubin toxicity when bilirubin levels are high enough to cross the blood-brain barrier
○Signs and symptoms: lethargy, irritability, seizures, coma, death
46
_Kernicterus_: Definition and S/S
●irreversible long-term effects of bilirubin toxicity
○Signs and symptoms: hypotonia, hearing loss, delayed motor skills, cerebral palsy
47
_Icteric_:
adjective used to describe being affected by jaundice
48
●Physiologic jaundice
○Common (occurs in ~60% term, 80% preterm infants)○Due to high levels of unconjugated bilirubin○Presents **_after_** 24 hours of life○Usually self-resolves without treatment
49
Pathologic Jaundice
○Less common○**Presents _in the 1st 24 hours_ of life○**Usually occurs due to a medical condition and/or severely high levels of bilirubin■Common cause is blood type incompatibility (**ABO or Rh incompatibility)**
## Footnote
\*more severe type of jaundice
50
●Breastfeeding-associated jaundice (**early-onset)**
○Occurs at 2-5 days after birth○Hyperbilirubinemia occurs due to lack of effective breastfeeding (breastfeeding itself is not a cause)
51
●Breast milk jaundice **(late-onset)**
○Occurs at 5-10 days after birth○Rare, unknown cause but likely factors in breast milk decrease ability to excrete unconjugated bilirubin
52
**Screening for Hyperbilirubinemia**
●Part of newborn assessment to inspect for jaundice
●Transcutaneous bilirubinometry (TcB or TcBilli) is a monitor used on the forehead of every baby before hospital discharge○Screening tool only (not reliable if bilirubin \> 15)
●If high, will obtain a total serum bilirubin level via heel stick for more accurate measurement
53
Jaundice Treatment
●Feeding → stooling → way to excrete unconjugated bilirubin○Physiological jaundice typically resolves with increased feeding
●Hyperbilirubinemia related to pathologic jaundice and/or very high levels, may require _phototherapy_○Light energy used to change shape of bilirubin causing unconjugated → conjugated for easier excretion → reduces circulating bilirubin
●_Exchange transfusion_: most invasive treatment if phototherapy is not sufficient or if encephalopathy/kernicterus occurs○Performed in NICU where infant's blood is replaced with donor blood
54
Phototherapy:
- Phototherapy does not use significant UV radiation. Opaque eye mask prevents retinal damage. Can increase heat loss via evaporation so important infant is still feeding q2-3 hours to prevent dehydration (only a diaper and eye protection) No lotion
- Many factors vary in phototherapy causing a unique experience for each individual baby based on their clinical findings
Goal of phototherapy: “bilirubin level should begin to decrease within 4 to 6 hours after phototherapy is initiated and within 24 hours should decrease by 30% to 40%”
55
Integumentary System in Baby
●So many NORMAL skin changes! Most self-resolve
●Vernix: prevents heat loss via evaporation; emollient, antimicrobial, and antioxidant properties; also decreases the skin pH, skin erythema, and improves skin hydration (in addition to possibly contributing to a healthy microbiome)- (white cheesy stuff)
●Lanugo:coarse body hair that will fall off
●Creases on the palms and soles of feet●
Milia:-small, whiteheads that look like baby acne
●Peeling (desquamation)
●Port wine stain (red birthmark-doesn’t resolve)
●Harlequin sign-a transient condition where half of the face appears red
●Mongolian spots- blue spots on back of rear end
●Stork bites (nevi)
●Erythema toxicum (newborn rash)
\*\*The soles of the feet should be inspected for the number of creases during the first few hours after birth; as the skin dries, more creases appear. More creases on the palms of hands and soles of feet correlate with a greater maturity rating.
56
Crytorchidism
failure of testes to descend; more common in preemies)
57
Hypospadias vs Epispadias
urethra is below tip of penis)
vs
(urethra is above tip of penis)
58
Molding:
overlapping of cranial bones during birth to allow passage through the birth canal → variations in shape of head
59
_Caput succedaneum_:
● “caput” or “cone head” caused by sustained pressure during birth → compression of vessels → ↓ venous return → edema
60
_Cephalohematoma_:
●blood collection between skull bone and periosteum○Does not cross suture lines; firmer and more defined than caput○Resolves within 2-8 weeks; usually occurs with caput succedaneum
61
Subgleal hematoma
can also occur and is rare but more severe; often occurs from the shearing forces of an operative delivery
62
**Apgar Scoring**
●Scores given at 1 and 5 minutes of life
●Scores are out of 10○If 5 minute Apgar is \<7, will repeat again at 10 minutes of life○If 10 minute Apgar is \<7, will repeat again at 15 and then again at 20 minutes (if needed)
●5 criteria, each get a score of 0, 1, or 2○Heart rate, respiratory effort, muscle tone, reflex irritability, color
●Nurse responsibility unless the pediatric team is present for delivery●Acrocyanosis normal in 1st 24 hours
●Apgar scoring does not predict future neurologic outcomes
63
Apgar Score adaptation:
0-3 severe distress
4-6 moderate difficulty
7-10 adapting
64
Apgar Heart Rate Score: 0,1,2
0: absent
1: Slow\< 100/min
2: \> 100/min
65
Apgar Respiratory Score: 0,1,2
0: absent
1: Slow, weak cry
2: Good cry
66
Apgar Muscle Tone Score: 0,1,2
0- flaccid
1- Some flexion of extremities
2- Well flexed
67
Apgar Reflex Irritability Score: 0,1,2
0-No response
1- Grimace
2- Cry
68
Apgar Color Score: 0,1,2
0-Blue, Pale
1- Body pink, extremities blue
2- Completely Pink
69
Newborn Growth
At term \>37 weeks, average measurements:
●Weight: 2500g-4000g (5.5lbs-8.8lbs)○Described in further detail based on gestational age using a growth chart○
_Appropriate for gestational age_ (AGA): Infants between 10-90th percentile○
_Small for gestational age_ (SGA): Infants \<10th percentile○
_Large for gestational age_ (LGA): Infants \>90th percentile
●Length: 45cm-55cm
●Head circumference: 32cm-38cm
70
Newborn Reflexes
●Some reflexes are vital for survival
●Rooting is a sign of hunger, sucking, sneezing, gagging
●Newborns are nasal breathers○~3 weeks a reflex develops causing mouth opening if nose obstructed
●Presence of reflexes reflects neurologic intactness and maturity
71
I/O's in Newborns
●Together with daily weights is a great indicator of feeding success
●In the first 3 days of life, the minimum # of expected wet and dirty diapers correlate with how many days old the baby is
●Meconium is first bowel movement and will transition over the next few days○Breast milk fed babies stools: black → green → yellow, seedy (sweet smell)○Formula fed babies stools: brown, thick (bad smell)
●Urine is usually straw colored and odorless○A sign of dehydration is pink-tinged uric acid crystals called “brick dust”
●Spitting up is common and normal. If excessive or appears painful, not normal
72
Newborn Screening Tests
●Bilirubin test
●Metabolic screening required by the state
●Hearing Test
●Critical Congenital Heart Disease (CCHD): pulse oximetry on two extremities
73
**Routine Metabolic Newborn Screening**
●Blood sample obtained via heel stick and sent to external lab○Results communicated with pediatric provider after discharge
●Must be performed after 24 hours for accuracy
●Required by the state
●Examples include phenylketonuria (PKU) and cystic fibrosis
74
Circumcision
●Optional medical procedure●Often performed by an OB/GYN●Performed after 24 hours of life●Requires “circ care” post-procedure○Involves gauze and vaseline○Monitor bleeding and healing○Continues 7-10 days post-procedure based on pediatric provider’s recommendations
## Footnote
Nursing Interventions:
●Assist with procedure in terms of comfort, gathering equipment, positioning baby, perform time out with doctor, circ care, education to family, assess I&Os
75
Prematures Risks:
* no fat deposits,
* difficulty maintaining temperature,
* decreased immune activity,
* immature organs (↑ risk for hyperbilirubinemia, ↓ kidney function,
* hypoglycemia)
* Respiratory distress due to absent or decreased surfactant, immature regulatory center, pliable thorax
76
**Necrotizing Enterocolitis (NEC)**
●Acute inflammatory bowel disease●
●Bowel swells → breaks down → unable to produce its own natural defenses → ↑ risk bacterial colonization
●Risk factors: preterm infants, formula fed
●Early signs and symptoms nonspecific: fatigue, abdominal distension
●Bowel rest is indicated; when safe to resume feedings, breast milk is best
●Nursing interventions: avoid rectal temperatures, infection control
**BABIES MAJOR AT RISK FOR INFECTION!!!**
77
**Neurologic Complications**
●Risk inversely proportional to gestational age
○Preemies have ↑ fragile cerebrovascular system, ↑ permeability of capillaries, prolonged PTT
●Hypoxic-ischemic brain injury
●Intraventricular or intracranial hemorrhage
○Ruptured vessel from ↑ cerebral blood flow to area
**●Treatment: Therapeutic hypothermia appropriate for late preterm and term newborns○Body or head cooling within 6 hours after delivery improves outcomes ○Otherwise supportive measures**
78
Inborn Errors of Metabolism: When do we test for these?
At 24 hours
79
**Neonatal Infections and Sepsis**
●A leading cause of neonatal morbidity and mortality●Symptoms often discrete and nonspecific○Important to catch early
## Footnote
Types:
●Early-onset (congenital): within 1 week of birth (often within 72 hours)
○Rapid onset○Inversely related to infant birth weight○Group beta strep (GBS) sepsis most common
●Late onset: occurs later than 1 week after birth (usually 7-30 days postpartum)○Community or hospital-acquired infections○Pneumonia and bacterial meningitis are most common
80
**Symptoms of Sepsis:**
●Early symptoms: lethargy, poor feeding, poor weight gain, irritability
●Later symptoms: temperature instability (typically hypothermia), diarrhea, vomiting, decreased reflexes, pallor, mottled skin, respiratory distress symptoms
81
**Drug-Exposed Infants : Symptoms**
●Symptoms: tachycardia, fever, diarrhea, projectile vomiting, nasal congestion, hyperactivity, irritability, excessive crying, perspiration, feeding issues
82
**Fetal Alcohol Syndrome Spectrum Disorder**
●Fetal alcohol syndrome (FAS)○Physical and behavioral symptoms plus anatomical manifestations
■Abnormal facial features (small eyes, thin upper lip, indistinct philtrum)
■Seizures most common; also jitteriness, increased tone, hyperreflexia, irritability
●Alcohol-related neurodevelopmental disorder (ARND)
○Behavioral and cognitive disabilities
●Alcohol-related birth defects (ARBD)
○Congenital cardiac, musculoskeletal, renal, and/or auditory manifestations
83
**Hemolytic Disorders**
●Most often occurs due to isoimmunization (usually Rh incompatibility)
○Less often associated with ABO incompatibility
●Most common reason for pathologic jaundice
84
What type of fetal heart tracing may be anticipated for Hemolytic Disorders in infants?
Sinousiodal
85
ABO Incompatibility
●When the birthing person has a different blood type than the baby and antibodies cross the placenta causing hemolysis in the newborn
●Most commonly occurs when birthing person is O and baby is not
○Due to birthing person with O blood type having anti A and B antibodies that can cross placenta
●Wide variability in maternal sensitization to Rh + antigens → wide variability in symptoms/effects
86
**Infants of Diabetic Mothers (IDM)**
●“Single most predictive factor of fetal well-being in a baby born to a diabetic mother is their euglycemic status”
○Uncontrolled blood sugars in early pregnancy increase risk of cardiac and CNS anomalies
○Respiratory distress is a concern due to reduced surfactant synthesis related to maternal hyperglycemia
●Hallmark signs and symptoms: macrosomia or LGA (↑ risk for shoulder and labor dystocia) and hypoglycemia○Can occasionally manifest as growth restricted (IUGR) or SGA
87
_Phenylketonuria (PKU)_: inborn errors of metabolism
● autosomal recessive enzyme deficiency unable to break down phenylalanine requiring strict dietary changes
88
_Congenital hypothyroidism_: inborn errors of metabolism
●variety of causes; requires thyroid hormone replacement
89
_Galactosemia:_ errors of metabolism
autosomal recessive leading to 1 of 3 enzyme deficiencies requiring specific dietary changes
90
**Respiratory Distress Syndrome**
●Lung disease characterized by immature lung development●Almost exclusive to preterm infants; insufficient surfactant is main cause
91
Respiratory Distress Syndrome Symptoms:
Tachypnea, Dyspnea, retractions, crackles, grunting, flaring of nares, cyanosis or pallor, apnea
\*with progressed condition deteriorating vital signs including BP, apnea, and body temperature instability
92
Breast Cancer Risk Factors:
●Similar as other cancers (age, obesity, family or personal history, unhealthy lifestyles)●Earlier menarche or later menopause●Less or later pregnancies/breastfeeding●Dense breast tissue
93
Perimenopause
●_Perimenopause_: length of time between the end of regular menstrual cycles until menopause
○Large variation among patients-average length is 4 years
○Transition phase with decrease in ovarian function and hormone production
○Decrease in estrogen → side effects
○Often characterized by irregular periods, vasomotor symptoms (hot flashes), vaginal dryness, insomnia
○Pregnancy can still occur!
94
Menopause:
●_Menopause_: the last menstrual period
○Cannot be confirmed until one year of no menses○Marked by a single event
95
Postmenopause:
●_Postmenopause_: begins one year after the last menstrual period
○Longest phase
96
**Chlamydia**
●Bacterial●Most common reported STI●Majority asymptomatic; post-coital spotting, dysuria, abnormal discharge ●PO antibiotics for patient and their partner is treatment●Pelvic inflammatory disease (PID) is most common complication●_Nursing interventions_: antibiotic education
97
**Gonorrhea**
●Bacterial●Often asymptomatic; yellow/green discharge, menstrual changes; rectal pain; diarrhea●Ceftriaxone IM is treatment●PID is a complication●_Nursing interventions_: encourage condoms or abstinence until fully treated to prevent reinfection; partners in last 30 days should be screened
98
Syphilis
●Bacterial●Types/symptoms:○Primary: Painless _chancre_ (lesion)○Secondary: maculopapular rash, lymphadenopathy, _condylomata lata_ ○Tertiary: multi-organ system failure, often preceded by a latent asymptomatic period ●Can progress to next stage and ultimately death if untreated○A J_arisch-Herxheimer reaction_ can occur (severe febrile reaction with headaches and myalgias within 24 hours of Penicillin treatment)●Penicillin G is treatment●_Nursing interventions_: Education-testing has high false positive and negative rates; monthly follow-up to ensure treatment is successful
99
**Human Immunodeficiency Virus (HIV)**
●*Incurable* virus●HIV progresses to acquired immunodeficiency syndrome when there is depression of cellular immunity●At risk for opportunistic infections and worse disease course is co-infected with HPV●Flu-like response, sore throat, rash, weight loss●Triple drug antiviral or highly active antiretroviral (HAART) keeps viral load under control●_Nursing interventions_: informed consent, counseling before and after testing, ensure confidentiality, encourage more frequent STI screening
100
**Humanpapiloma virus (HPV)**
●Also known as condylomata acuminata or genital warts●Most common sexually-transmitted virus●Types: 100+ strains○Most low-risk strains cause genital lesions○High-risk strains increase risk for genital tract cancers, especially cervical cancer ●Painless lesions, dyspareunia (painful sex), abnormal discharge●HPV and lesions mostly self-resolve; if don’t, colposcopy and/or loop electrosurgical excision procedure (LEEP) remove precancerous cells●_Nursing interventions_: determine if candidate for HPV vaccine series, educate, ensure up to date with screening
101
**Herpes Simplex Virus**
●Type: *Incurable* virus●Types: HSV-1 (oral) and HSV-2 (anal) but can be transferred via other routes○Primary outbreak: painful and itchy lesions, flu-like symptoms, discharge○Secondary outbreaks: less severe, recurrent lesions●Antiretroviral for episodic or suppressive therapy●In pregnancy, daily preventative treatment in third trimester because outbreak at time of labor requires a cesarean●_Nursing interventions_: ensure pregnant patients with history start antiretroviral suppression therapy ~36 weeks, educate
102
**Trichomonas**
●Protozoan●Most common STI and likely underreported●Often asymptomatic or yellow-green vaginal discharge, dysuria, dyspareunia, petechiae “strawberry spots” on cervix●Antibiotic as treatment●Nursing considerations: educate, reassure
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Vaginal Infections: Bacterial vaginosis
●Most common vaginitis●Anaerobic bacteria replacing healthy lactobacilli, changing the vaginal pH●Symptoms include vaginal “fishy” odor, discharge, itching●Nurse must counsel on antibiotic use and lifestyle changes
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Vaginal Infections: Yeast (vulvovaginal candidiasis)
●Risk factors: antibiotic use, high sugar diet, diabetes, pregnancy, immunosuppression●Symptoms include itching, white discharge, pain with urination or intercourseNurse must counsel on antifungal and alternative remedies as well as lifestyle changes
\*\*\*These are NOT sexually transmitted but the change in pH of the vagina when it comes in contact with semen can increase the risk for these vaginal infections
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Contraceptive Barrier Methods: Most effective condoms
●Physical barrier preventing semen from entering vagina●Only contraception option that protect against STIs!●Different types:○Male and female condoms○Diaphragm: dome-shaped device that covers cervix○Cervical cap: (Femcap) 3 sizes that acts as a physical barrier over the cervix○Contraceptive sponge: sponge with spermicide and water that fits over cervix; one size fits all●Efficacy: Condoms: typical use (15% failure); Diaphragm: 4-8% with perfect use and 13-17% with typical use plus spermicide (cervical cap less)●Rare side effect of all except condoms is _toxic shock syndrome_ (sunburn-type rash, flu-like symptoms)
●_Nursing interventions_: condom education; most diaphragms require fit and proper placement ; all except condoms must be kept in place for 6 hours after intercourse so spermicide can work; education about proper use and storage
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**Spermicides and Phexxi**
●Chemical barrier●Recommended for use with diaphragms and cervical caps but NOT condoms●Does not protect well against STIs and if used more than twice daily, has even been found to increase HIV transmission●Different types:○Spermicides: chemicals that reduce sperm motility; many different routes available ○Phexxi: contraceptive gel that alters the vaginal pH; applicator inserted like a tampon within 1 hour _before_ sex; can be used with any other form of birth control to enhance efficacy (except vaginal ring)●Efficacy: spermicides have 15-29% failure rate; Phexxi 86-93% effective ●_Nursing interventions_: educate, especially about methods that can and can’t be mixed
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**Combined Hormonal Birth Control Methods**
●Suppresses menstrual hormones to prevent ovulation, thickens cervical mucus, and thins uterine lining●Different types: pill, patch, vaginal ring and many different formulations of the pill○Pill: taken daily, may have placebo “sugar” pills○Patch: new patch placed weekly for 3 weeks then 1 week without patch○Vaginal ring: ring inserted for 3 weeks then removed for 1 week●Efficacy: Typical use 91% efficacy (pills), \<9% failure rate (patch & vaginal ring)●Side Effects depend on type of pill: depression, nutrient depletion, water retention, decreased libido●Interactions: should not be taken with anticonvulsants, TB drugs, and some HIV meds●Contraindications: history of blood clots, breast cancer, liver disorders, lactation, \<6 weeks postpartum, smoking if older than 35 years of age, migraines with aura, surgery with prolonged immobilization, severe hypertension, and diabetes with vascular involvement●_Nursing interventions_: education, ACHES warning signs, recommend prenatal vitamins to anyone of childbearing age
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**Combined Oral Contraceptive Warning Signs:**
Abdominal pain
Ches Pain
Headaches
Eye problems
Severe leg pain
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**Progestin-Only Contraception Methods**
●Inhibits ovulation by decreasing and thickening cervical mucus, thins endometrial lining, and alters fallopian tube●Different types: pills (“Minipill”), arm implant, shot, intrauterine device○Pill: even more sensitive than COCs and must be taken within the same 3 hours every day○Shot (DMPA): 1 injection every 3 months○Arm Implant (Nexplanon): thin, rod inserted into arm and lasts up to 3 years○IUD (Mirena, Skyla, others): T-shaped device inserted into the uterus and lasts 2-5+ years depending on type●6% failure rate for DMPA shot; for implant and IUD: perfect = typical use ~99% efficacy●Side Effects: Irregular bleeding/spotting; DMPA shot side effects include temporary bone density loss and long return to fertility●Good candidates: those who combined oral contraceptives are contraindicated for●_Nursing interventions_: reiterate that timing is _key_ for pills, anticipatory guidance about spotting/side effects; administer shot, educate
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**Intrauterine Devices**
●T-shaped attached to strings inserted into uterus through the cervix; hormonal IUDs work the same as progestin-only methods; non-hormonal IUDs work because copper acts as a spermicide and inflames the endometrium●Different types: non-hormonal (copper) and hormonal (progestin-only)●Perfect use = typical use (1.7% failure rate); effective for 2-10 years depending on type●Copper IUD can cause heavier and more painful periods the first year of use; increased risk of PID if infection present at time of insertion; rare risk of uterine perforation upon insertion●_Nursing interventions_: anticipatory guidance about insertion; educate on signs of infection; instruct on how to check strings to confirm placement
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**Long-Acting Reversible Contraception (LARCs)**
●Arm implants●Intrauterine devices●Perfect use = typical use because no room for “user error” ~99%
## Footnote
Signs of complications of intrauterine devices:
Period late: abnormal spotting
Abdominal pain; pain with intercourse
Infection exposure; abdominal dischage
Not feeling well, Fever or chills
String missing, shorter or longer
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**Sterilization/Permanent Contraception**
●Surgical occlusion of ova (fallopian tubes) and sperm pathways● (vas deferens) or removal of female organs (uterus and/or ovaries)●Different types: male (vasectomy) outpatient procedure or female (tubal ligation procedure)●Perfect use = typical use; failure rate \< 57/1,000 for female●Reversal possible for occlusion of pathways but not always successful ●_Nursing interventions_: client education, ensure male patients follow-up for repeat semen analysis after 3 months; ensure 30 day mandated wait period before signing paperwork and sterilization occurs
