Final Flashcards
(162 cards)
1
Q
Normal Fetal HR
A
110-160
2
Q
Teratogens
A
TORCHZ
Toxoplasmosis
Other - glucose, dry cleaning fluid, pesticides
Rubella
Cytomeglovirus
Herpes
Zika
3
Q
Presumptive Signs of Pregnancy
A
May mean pregnancy
Amenorrhea
Breast Tenderness
Fatigue
Potential spotting 6-10 days after ovulation
4
Q
Probable Signs of Pregnancy
A
Objectively observed by examiner
Positive urine HCG
Chadwick’s – bluish color of vagina/cervix
Hegar’s Sign – softening of uterine walls/isthmus
Goodell’s Sign – softening of cervix
5
Q
Positive Signs of Pregnancy
A
Can only mean fetus present
Palpate maternal pulse and then locate second (fetal) pulse
Visualize fetus on US
Palpate fetal movement
6
Q
Maternal exam: Normal vs Abnormal Skin Findings
A
Normal - pink or tan; linea nigra, cholasma, striae, pruritc urticarial, papules, plaques of pregnancy (PUPS)
Abnormal - red, pale, grey, jaundice; bruising, MRSA,
7
Q
Maternal Exam: Normal vs Abnormal Face
A
Abnormal - swelling
8
Q
Maternal exam: Normal vs Abnormal Eyes
A
Normal - white sclera, normal dilation, PERRLA, EOM w/o nystagmus
Abnormal - yellow sclera, overdilation, pupil constriction, EOM w/ nystagmus
9
Q
Maternal Exam: Normal vs Abnormal Mouth
A
Normal - tonsils 0 1 2, tonsils symmetric, no inflammation
Abnormal - lesions, HSV, HPV, tonsils 3 or 4, asymmetric tonsils, inflammed tonsils, dry mucus membranes
10
Q
Maternal Exam: Normal vs Abnormal heart
A
Normal: systolic murmur, S3
Abnormal: diastolic murmur, S4
11
Q
Maternal Exam: Normal vs Abnormal Lungs
A
Normal: 12-20 respirations
Abnormal: wheezes, crackles, stridor, frictionrub, tachypnea, bradypnea, decreased oxygenation
12
Q
Neonate Exam: Normal vs Abnormal Posture
A
Normal - flexion
Abnormal - extension
13
Q
Neonate Exam: Normal vs Abnormal Cry
A
Normal - lusty, vigorous
Abnormal - weak or absent
14
Q
Neonate Exam: Normal vs Abnormal Skin
A
Normal - thick, peeling
Abnormal - clear, translucent, cracked, leathered
15
Q
Neonate Exam: Normal vs Abnormal Lanugo
A
Normal - mostly or entirely bald
Abnormal - abundant, thinning
16
Q
Neonate Exam: Skin
A
Normal - vernix, milia, mongolian spots, erythemia toxicum, telangietic nevi
17
Q
Neonate Exam: Head
A
Normal - caput
Abnormal - cephalhematoma
18
Q
Neonate Exam: fontanels
A
Normal - open, overriding, molding
Abnormal - fused, bulging (unless crying), depressed, sunken, fused
19
Q
What are abnormal contraction rates?
A
Less than 3 minutes
Longer than 90 seconds or absent
20
Q
Abnormal Fetal heart Tones
A
Absent - hypoxia, brain damage
Minimal - 1-5 beats longer than
20 minutes - hypoxia/asphyxia, acidosis, drugs
21
Q
PROM
A
Spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor at any gestational age
Oxytocin may be given
22
Q
APGAR
A
Scored 0 to 10, with 7 to 10 being okay/supportive care
Heart rate >100
Cry - should be vigorous
Tone - should be flexed
Reflex irritability
Color - should be acrocyanosis or pink
Respiratory effort
23
Q
Why do we use the ballard exam?
A
Estimates gestational age/maturity
Can be used up to 4 days post birth
Assess physical and neuromuscular activity
24
Q
Neonate Axillary Temp
A
97.8-99.5F
25
Neonate HR
110-160
26
Neonatal RR
30-60
27
Neonate O2 Sats
> = 95
28
What is the triad of doom? Give specific numbers
Respiratory distress (grunting, nasal flaring)
Hypoglycemia <45
Cold stress <97.8
29
How do we test for Rh incompatibility?
Indirect Coombs - detects antibodies in Mom against Rh - fetus
Direct Coombs - detects antibodies against Rh+, performed with PUBS
30
First Trimester Ultrasound
Ask mom to drink 3-4 glasses of water and to not urinate
of fetuses
presence of fetal cardiac movement/rhythm
uterine abnormalities
gestational age
31
Chorionic Villi Sampling
Performed at 10-12 weeks gestation
Evaluates DNA, bleeding, infection or miscarriage risk
32
Biochemical analysis
Tay Sachs
1st Trimester
33
Rh Incompatibility
AKA isoimmunization
When mom is Rh- and baby is Rh+, it has inherited this gene from the Dad, mom will create antibodies against the fetus, typically the first pregnancy is not affected, but antibodies grow with future pregnancies
If not treated, then fetus can become anemic or jaundiced with immature RBC production
No impact if mom is + and baby is -
Complication: Hydrops Fetalis
34
Non-Stress Test
Evaluates fetal oxygenation
Reactive=normal; 2 accels (15x15) in 10-20min
If nonreactive, then will need biophysical profile (in utero) and apgar (out of utero)
35
Early Decelerations: What are they? Interventions?
Before peak of contraction
Associated with head compression resulting in vagus stimulation and slowing of HR
NO interventions, baby is coming
36
Variable Decelerations: What are they? Interventions?
Resemble U, V, W
Associated with cord compression cutting O2 at random times
Nursing Interventions:
- change maternal position
- drink juice
- stop pitocin
- administer O2
- vaginal exam for cord prolapse
- Severe - amniocentesis
37
What are normal contraction rates?
Every 3-5 minutes
Last 45-90 seconds
Uterus is soft and relaxed between contractions
38
Variable Fetal Heart Tones
Normal is 6 to 25 beats
IF <5, fetus may be sleeping
39
VEAL CHOP
Variable Cord Compression
Early Head Compression
Accelerations OK
Late Placenta issue
40
Abortion: Types, S/Sx
Elective or spontaneous
No fetal viability before 20weeks
S/sx:
Uterine Cramping
Vaginal Bleeding - bright red
Pelvic Pressure
Backache
41
Ecotopic Pregnancy: What it is, S/Sx, Treatment
Fertilized ovum outside uterus in fallopian tube
S/Sx:
UNILATERAL, sharp abdominal pain
Normal pregnancy symptoms
positive pregnancy test
If suspected you can perform gentile uterine palpitation
Treatment:
NPO if surgery (sometimes sent home on methotrexate)
VS
Monitor for signs of bleeding, including Cullen Sign
Type and Crossmatch blood
42
Molar Pregnancy
Degenerative placenta, fertilized egg without embryo but incorrect chromosomes
Characterized by grape-like clusters
S/Sx:
Preeclampsia prior to 20 weeks
NO FHT or skeleton
hCG continues to rise when it should decline
Abnormal uterine bleeding
Uterus larger than dates
Anemia from blood loss
Excessive vomiting
Abdominal cramping
Treatment:
- Prep for D&C
- Monitor hCG levels for 1-year: monthly for first 6-months then every 2 months for 6-months
-No pregnancy for 12-months as pregnancy can mask symptoms of chorioncarcinoma
- Possible prophylactic chemo
43
Gestational Diabetes: What’s happening, risks?
Hormonal changes increase maternal insulin resistance to ensure baby has enough glucose
Insulin resistance due to placental hormones (insulinase and cortisol)
Moms are more prone to preeclampsia, hemorrhage, infection, hydroaminos and macofetus
44
Macroscopic Fetus
> 4000g
May cause prolonged 2nd labor stage, head injury or shoulder dystocia
If C-section, then baby may have respiratory distress due to absence of vaginal squeeze
Baby may experience hypoglycemia - if >5000g may last for 1 week
Very large babies need to be vented or receive supplemental O2
45
Respiratory Distress in GDM
Caused by decreased surfactant
Increased risk ventilation or supplemental oxygen
46
In GDM, what happens in 3rd stage of labor to mom?
Insulin requirements drop substantially in first 24-hours, recommended to discontinue long acting insulin before delivery.
Mom recommended to breast feed for better glucose control
Hospital Care:
5% glucose infusion
Monitor ketones
monitor hemorrhage
47
Neonatal Hyperproliferation of Pancreas
Enlarged pancreas due to high maternal glucose which causes increased insulin needs in fetus, but when umbilical cord is cut then no constant source of glucose but pancreas continues to put out high levels of insulin
Resolves in 4hrs, but if baby is >5000g then it can take a week
48
Fetal Lung Maturity
Based on LS - lecithin:sphingomyelin ratio
Accounts for AFV changes
Tested via amniocentesis before induction
Considered mature if ratio >2.2 or if PG (phosphatidyglycerol) is present in surfactant past 36 weeks
49
Preeclampsia: S/Sx, medication, complications
HTN after 20-weeks gestation with no history of HTN
S/Sx: (acronym = pre)
Proteinuria
Rise in BP (>140/90 on 2 occasions) or >160/90 on shorter occasions
Edema
Rapid weight gain >2lbs/week
Decrease UOP
Hyperrefelxia 2+ Clonus
Medication:
Labetaol
Hydrazine hydrochloride
Complications: eclapsia, HELLP syndrome, DIC
50
Eclampsia: S/Sx, treatment
Pregnancy HTN w/ seizures
S/Sx
Persistent headache, blurred vision, epigastric/RUQ pain, AMS, SEIZURE
Medication: MgSO4 before and 24-hours post if no signs of toxicity;
Treatment:
Side- lying position
oxygen
51
HELLP Syndrome
Life threatening complication of preeclampsia
S/Sx (HELLP)
Hemolysis
Elevated Liver enzymes
Low Platelet count
Malaise
epigastric/RUQ pain
N/V
Normotensive w/o proteinuria
Treatment: MgSO4
52
Signs of DIC
bleeding gums or nose
reduced lab values for platelets and prothrombin
Bleeding from IV sites
Ecchymosis
53
MgSO4 Toxicity
Therapeutic Range: 4-7 mg/dL
MgSO4 also hs increase risk of post partum hemorrhage has it relaxes muscles and uterus not able to contract
S/Sx:
ABSENT DTR
Decrease RR
Diaphoresis/flushing
Warmth
EKG Changes
Decreased UOP but increase in mag level
Antidote: calcium gluconate
54
Fetal Movement
Evaluate fetal oxygenation
55
Fetal Kick Counts
Fetal movement evaluates fetal oxygenation
Emergency: No kick counts of <10 in 12 hours
56
Contraction Stress Test
Evaluates fetal oxygenation and ability to tolerate contractions w/o placental insufficiency
negative contraction test is desired
positive indicates late DHR decelerations
57
Biophysical Profile
IN UTERO
Looks for signs of distress
Assessment of fetal well-being based on 5 factors
1) fetal breathing movement
2) Fetal movement
3) fetal tone
4) Reactivity of FHR/ reactive NST
5) AFV
Score of 2 or 0 can be assigned, fetal well-being 8-10 is healthy
58
Amniocentesis: What is it, when is it performed, what does it determine, complications
Performed at 20 weeks
Anatomy or DNA for high-risk moms (>35 or MSAFP elevated or decreased)
Determines:
karotype
biochemical analysis
AFV
Fetal lung maturity
Fetal well-being
Complications: infection, miscarriage, bleeding
59
Fetal heart Echo
Fetal heart sonogram for structural abnormalaties
60
STI
Mom has an infection and we can give antibiotics (bacterial)
61
STD
Mom has an infection and cannot clear it but can manage symptoms (viral)
62
Stage 1
Early/latent 0-5cm
Active 6-10cm with cervical dilation
63
Stage 2 labor
Pushing and birth of neonate
Ends with delivery of baby’s feet
64
Stage 3 Labor
Delivery of placenta
Must not exceed 20 minutes due to dilated uterine veins and increased hemorrhage risk
65
Stage 4 labor
Recovery
Lasts 2 hours after delivery of placenta - q15m for 1 hr, then q30min for 2 hours
Fundus should be firm and midline NOT soft, boggy or displaced
66
Why can the placenta be retained? Interventions?
Break or tear in the placenta
Use of oxytocin before delivery of placenta
Treatment:
Inspect placenta for breaks
US
Manual removal – D&C or vaginal
67
What is the position for pushing?
Lithotomy
68
Normal Blood Loss: Natural vs C-Section
Natural 500mL
C-Section 1000mL
69
Bishop Score: What is it?
Assesses cervix induciability
Scores range 0-13
Score > 8 indicates induction likely to be successful, and cervix is soft and anterior, 50% or more effaced, dilated 2cm or more, presenting part engaged
70
Cervical Ripening
Prostaglandin Gel (E1 and E2)
Misoprostol/Cytotec
Foley bulb
Hydroscopic dilators - laminara
71
Oxytocin: Use and Risk
Use:
- Induce labor
- Augment slow labor
- Used after placenta is delivered to encourage uterus to contract, if given before delivery of placenta it can cause placenta to be retained
Risks -
Hemorrhage - made uterus work harder than it would have
72
Amniotomy
Manual rupture of membranes
Used with oxytocin/pitocin to induce labor
Risk of prolapsed chord
73
Operative Assistive Birth: Forceps: Maternal and Baby Risk
Maternal Risk: vaginal laceration, risk of pp hemorrhage
Baby Risk: Bruising
74
Operative Assistive Birth: Vacuum Extraction - what is it, baby risk,
Used to get baby under pelvic bone
Baby - cephalohematoma or skull fracture, caput succedaneum due to vacuum cup
Can only be used 2 times/2 pop offs
75
Duramorph
Used post c-section to manage pain
Long acting morphine (24hrs)
Nurses may forget it is on board and increased risk for respiratory depression
76
C-Section
Birth through transabdominal incision
NO VBAC for classical c-section - look at operative report
77
When do you not give tocolytics?
DO NOT GIVE if HR >110-130
78
What medication provides cerebral neuroprotection?
MgSO4
79
Fetal Fibronectin (fFN)Test
Predicts who will NOT go into preterm labor
Women with negative test have less than 1% chance of giving birth within 2-weeks
Tests fFN, a glycoprotein found in plasma during fetal life
80
Preterm Birth: Cervical Length
Cervical length >30mm in 2nd and 3rd trimester unlikely to give birth prematurely
81
Risk factors for preterm labor/birth
ART
Hx of previous preterm birth
smoking
cocaine
multifetal gestation
uterine anomoly
82
PPROM
Membranes rupture BEFORE 37 weeks
Preceeded by infection - chorioamionitis
Tocolytic to stop labor, steroid to enhance fetal lung maturity and antibiotic will be given
83
Chorioamnionitis: What is it? S/Sx? Treatment? Fetal Risks?
Bacterial Infection
S/Sx:
- Maternal fever
- Maternal/fetal tachycardia
- Foul odor in amniotic fluid
Treatment: amp/gent
Fetal Risks:
-meningitis
-PNA
-Bacteremia
84
Postmaturity Syndrome
Decreased SC fat
Infant lacks lanugo/vernix
Dry, cracked and peeling skin
Meconium stained skin
Baby will have wasted appearance
85
Hypotonic Uterine Dysfunction:
Occurs during active phase
Woman makes normal progress into active phase, then contractions are weak and inefficient or stop altogether
86
Hypertonic Uterine Dysfunction
Occurs during latent phase of stage 1
Frequent contractions that are ineffective in causing cervical dilation or effacement
Mom needs rest
87
Tocolytic Medications
Given to delay birth until transferred to facility where corticosteroids can be given to enhance fetal lung maturity
Magnsium Sulfate
Terbutaline
Nifedipine
Indomethacin
88
Terbutaline Contraindications
Do not give if HR >110-130bpm or BP < 90/60
Assess for chest pain, MI, pulmonary edema
89
Precipitous Delivery
Labor is less than 3 hours from start of contractions
Associated with increased hemorrhage risk
90
First Degree laceration
involves epidermis
91
Second Degree Laceration
Involves epidermis, dermis, muscle and fascia
92
Third Degree Laceration
Extends into anal sphincter
93
Fourth Degree Laceration
Extends up rectal mucosa
94
Episiotomy Interventions
<24 hrs ice pack
>24 hours - warm sitz bath, epifoam, tuck
95
Pudendal Block
Blocks vaginal pain, perineum pain
useful for vacuum, forceps, vaginal delivery w/ epiotomy
96
Epidural Anesthesia
Blocks uterine pain
Usually IV/IM opioids
Contraindications - MRSA, spinal surgery, idiopathic, thrombocytopenia
97
Epidural Interventions: Pre, During, Post
Pre - fluids to prevent hypotension
During - positioning, safety, monitoring HR
Post - SAFETY, bladder, bp monitoring, continuous fetal monitoring, perineal care
98
Use of sedatives
Anxiety, induce sleep
99
Fentanyl
Never give 1hr before delivery due to risk of neonatal respiratory depression, safety, and fetal monitoring
100
Stadol and Nubain
NEVER give 1hr prior to delivery due to risk of neonatal respiratory depression, safety and fetal monitoring
101
Primapara Labor and Delivery Length
14+ hours
Based on fetal position, size, and contractions
102
Multipara Labor and Delivery
8+ hours
Based on fetal position, size, and contractions
103
Placental Abruption: Patho, assessment, intervention
Placenta tears away from decidua causing mom to hemorrhage
Asssessment:
- New onset pain, despite epidural
- Bleeding
- Hard, firm abdomen
Intervention: stat c-section
104
Placenta Previa: patho, assessment, intervention
Placenta implanted lower
Assessment:
- Vaginal bleeding, bright red
- No pain
- Soft uterus
Intervention: prep for c-section
105
Prolapsed Umbilical Cord: patho, ews, intervention
Fetus in negative or high station
Fetus not vertex/cephalic
Membranes ruptured and cord delivers or proplapses and is compressed (no O2 or CO2 exchange)
EWS:
- Fetal heart tone
- Variable decel
Intervention:
- knee/chest
- Trendelenburg
- Stat c-section
106
Shoulder Dystocia: Clinical Sign, Intervention, Maternal Risks, Fetal Risks
Turtle Sign - head is born, but anterior shoulder not able to pass under pubic arch
Intervention
- Stool
- McRobert’s posiiton
- Suprapubic pressure
Maternal Risks:
- PP hemorrhage
- Internal bleeding
- 4th degree laceration
Fetal Risks:
- Facial bruising
- broken clavicle
- Brain damage
- brachial plexus injury
107
Amniotic Fluid Embolism: patho, assessment, interventions
Patho:
Amniotic fluid crosses into placental circulation then maternal circulation, passes through heart causing major asphyxiation
Assessment
VS
Lung sounds
Decreased LOC
Respiratory changes
Interventions:
- Code
- Start CPR
- Transfer to ICU
- C-Section if not delivered yet
108
Postpartum Hemorrhage: What is it? Clinical Signs, Causes
Cumulative blood loss > 1000cc w/ in 24-hours of delivery
OR
Blood loss partnered with signs associated w/ hypovolemia 24hrs of delivery
Clinical Signs
- Soaked peripad in 15 minutes
- VS changes
- WIdening pulse pressure, increase HR, narrowed/decreasing bp, decrease O2 sats, pallor, then gray
Causes:
Tone
Trauma
Tissue
Thrombin
109
Treatment for Uterine Tone/Atony Hemorrhage
Fundal massage
Oxytocin, cytotec, methergine, hemobate
110
Treatment for Uterine Tissue Retained
Inspect placenta for breaks
US
D&C or vaginal removal
111
S/Sx and Treatment for Uterine Trauma
S/Sx
- Inspect for lacerations, rupture, inversion, hematoma
Treatment: repair tissue, evacuate hematoma
112
Who is at risk for PPHemorrhage?
Grand Multipara (>5 pregnancies past 20 weeks)
Twins/Triplets
Macrosomia >4000g
Uncontrolled diabetes
Polyhydroaminos
Fibroid uterus
Uterus worked too hard - labor >24 hours, oytocin, precipitous delivery
Sick uterus - HTN, MgSO4, chorioamnionitis
113
Lochia Rubra
Dark Red
Should subside by day 5
114
Lochia Serosa
Blood with serum
3-4 weeks
115
Lochia Alba
White cells shedding with mucus
116
Postpartum Depression: S/Sx, How is it assessed?
S/Sx:
withdrawn
appetite changes
anxiety
crying/sadness
fatigued
difficulty concentrating
less responsive
suicidal ideation
Measured with Edinburg scale
117
How much Tylennol can you have in 24-hours?
4000 MAX
Anything over 3000 is unsafe
118
Postparum Pain meds
Percocet - has Tylenol in it
Ibuprofen
Extra strength Tylenol
Toradol
Narcan
119
Postpartum bowel drugs
Bisacodyl
Colace
Percocet
Peri-colace
Simethicone/mylicon
120
Why is simethicone/mylicon given to c-section patients?
Eliminates trapped gas
121
Why do we prescribe progesterone only pills post c-section?
Estrogen decreases breast milk
Micronor
Depo
122
Why do we want patients to wait 3-weeks before progesterone only pills?
Establish max breast milk
Clotting risk returns to normal
123
Rhogham
Given if mom is Rh negative and baby is Rh positive
Must be given within 72 hours of delivery
Prevents Rh isoimmunization
124
Rubella Vaccine
Given post partum since it is a live vaccine
Avoid pregnancy for 1 month due to teratogenic effect
Protects future pregnancies
125
Dtap
whooping cough prevention
126
Neonatal Abstinence Syndrome: What is it? Substances that put baby at risk?
Infant born with dependence on alcohol or drugs due to maternal use/abuse
Substances:
Pot, cocaine, crack, heroine, lortab, xanax, percocet, methadone, subutex, ocycodone, alcohol
Systems -
127
Neonatal S/Sx of withdrawal
Hyperactivity
Shrill cry
Tremors, seizures
Sneezing, yawning
Disturbed sleep
Drooling, poor sucking
Tachypnea
Poor feeding
nasal congestion
vomitng
diarrhea
sweating
mottling
128
How do we care for babies with NAS?
Cluster care - feed, medicate, diaper, console and let them rest
Provide for uninterrupted sleep
129
Ductus Venous
Vein to vein
Last to close - benign - creates 2 lobes of the liver
130
Foramen Ovale
First to close during first minute of life
131
Ductus arterosis
artery to artery
Must close within 24-48 hrs or may cause irreversible heart and lung damage
132
Fetal Circulation in-utero
ductus venous
shunt
right atrium
shunt
formamen ovale
shunt
ductus arteriosis
shunt
133
Surfactant Administration
Administered via ET tube as adjunt to O2 and vent therapy to prevent and treat RDS in premature infants
134
Prevention of RDS
Surfactant provided at birth to infants with clinical manifestations of surfactant deficiency or with birth weight <1250g
135
Treatment of RDS
Surfactant administered to infants with confirmed diagnosis of RDS w/ in 8-hours of birth
Monitor for signs of diuresis as this can signal improvement
136
Adverse Effects of Surfactant
Respiratory distress immediately administration, bradycardia and O2 desaturation
137
What is conduction?
Placed on cold surface
Always put blanket on scale before placing baby
138
What is evaporation?
Baby is wet after delivery and water cools baby quickly, dry baby off immediately
139
What is convection?
Baby is under ac vent or fan, do not place warmer near fan or ac vent
140
What is radiation?
Baby placed near cold surface, baby is warmer than bed so bed will warm and baby will cool
141
Infant ABC
Airway - nasal breathers; suction mouth then nose
Breathing
Circulation
142
How many wet diapers?
Voids within 4-6 hours of birth, then should use 1 diapers for each day of life until day 6 when they should produce 6-8 wet diapers
Initial voiding may have brick-red dust
143
When do we screen for PKU?
24-hours after breast milk or formula ingestion
144
Stool Progression
Meconium - black, tarry, sticky
Transitional (yellow-green)
Milk stool - yellow
145
Vit K
Prevents hemorrhagic disorder in newborn
NB not born with sterile gut, no enteric bacteria to create vit K
Given IM 1st hour after birth in vastus lateralis
146
Conjugated vs unconjugated bilirubin
Unconjugated bilirubin bound to albumin and requires an accelerator to be rid of
Body can excrete conjugated
147
Kernicterus
Permanent brain damage from sustained bilirubin > 21mg/dL
Bilirubin moves from blood into brain tissue
148
Normal Serum Glucose Neonate
40-80
149
Erythromycin
Prevents opthlmalia neonatorum and chlamydia conjunctivitis
Thin layer of ointment along lower lid in conjunctival sac
Only one tube per baby
150
Meconium Aspiration Syndrome
Meconium passed into amniotic fluid, hypoxia results and causes chemical pneumonitis if not relieved right away
Risk Factors: IUGR, post-term neonate, fetal distress
Treatment: suction after head delivered, O2 and vent, pulm hygiene, antibiotics, bicarbonate
151
Necrotizing Enterocolitis
Vascular ischemia affecting GI mucosa due to perforation
Appears after initial feeding
S/Sx: abdominal distention, pallor, poor feeding, gastric residual 2ml, + guaiac test, increased apnea
Treatment:
NPO w/ NG suction on low, intermittent
Monitor dehydration
abx therapy
Risk Factors:
Asphyxia, RDS, polycthemia, umblical catheter
152
Group B Strep
Causes generalized sepsis, septic shock
153
Who is a candidate for estrogen/progesterone therapy?
No history of breast cancer b/c estrogen causes most cancers to grow
NO blood clots
NO liver problems
No migratine headaches with auras
No heart disease
Postpartum and within 3 weeks of delivery
No breastfeeding
154
BRAIDED
Used for contraception
Benefits
Risks
Alternatives
Inquiries
Decisions
Explanations
Documentation
155
ACHES
Warning signs to teach women taking COCs (combined oral contraceptives)
Abdominal pain
Chest Pain
Headaches
Eye problems
Severe leg pain
156
A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurses best response?
“Your current medications will reduce the effectiveness of the pill.”
157
When does emergency contraception need to be taken to be effective?
Within 72 hours of unprotected sex
158
An unmarried young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share?
“The risk of pelvic inflammatory disease is higher with the IUDs and multiple partners”
159
A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy?
Take one pill at the same time every day.
160
Candidate for oral or injectable progesterone?
Almost everyone except patients with breast, cervical or endometrial cancer and liver disease
161
Progesterone IUD
Progesterone delivered 24hrs day
Very reliable b/c progesterone is high during luteal phase preventing luteal bed from growing so creates negative feedback when given during follicular phase
Also decreases cervical mucous which decreases sperms ability to travel to fallopian tubes
Contraindications:
Postabortion or partum
gonorrhea
Chlamydia
pelvic TB
unexplained vaginal bleeding
162
Copper T IUD
Non hormonal
Prevents endometrial bed from maturing, damages cervical mucus
