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Final Third of Class Flashcards

1
Q

what is the single most dangerous event in a lifetime for a female

A

pregnancy

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2
Q

medical uses of contraception (beyond preventing pregnancy)

A 
helps w/ irregular periods
reduces dysmenorrhea
decrease acne
treats PCOS
protection from PID, ovarian and endometrial cancer, fibrocystic breast disease, ovarian cysts, fibroadenomas of breast, anemia and STIs
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3
Q

least effective method of contraception

A

fertility awareness based d/t user error and complications

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4
Q

symptothermal

A

calendar/mucus/body temp/standard

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5
Q

what causes increase temp during ovulation

A

usually spike during ovulation d/t increased progesterone

use contraception that day and 3 days after

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6
Q

billings (mucus)

A

before ovulation - clear, water, stretchy (estrogen dominant)
thick, white and sticky when not fertile (spinnbarkeit)

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7
Q

Standard method: if you have a regular cycle (26-32).. when to avoid sex

A

days 8-19

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8
Q

calendar rhythm method

A

record cycles for 6 months
take shortest cycle and subtract 18 days
take longest cycle and subtract 11 days
don’t have sex b/w those days

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9
Q

barrier methods

A

second least effective
prevent sperm from entering uterine cavity
d/t user error and inconvenience

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10
Q

types of barrier methods

A

condoms (male and female)
contracetpive sponge
cervical cap
diaphragm

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11
Q

contraceptive sponge

A

moisten sponge with water

leave in place for 6-8 hours post coital (less than 24 hours)

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12
Q

What to avoid with condoms (3)?

A

avoid oil based lubricants, monistat, estrogen creams

Also female condom can be inserted 8 hours prior to coitus

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13
Q

diaphragm

A 
requires fitting and referring
requires spermicide
leave in place for 6-8 hours post coital
no more than 24 hours
clean with soap and water
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14
Q

cervical cap

A

requires fitting
requires spermicide
leave in place for 6-8 hours post coital (no more than 48 hours)

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15
Q

spermicide risk

A

vaginal walls become more susceptible to HIV

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16
Q

hormonal methods

A

COC
vaginal ring
progestin minipill
patch

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17
Q

what pill do you use while breasfeeding

A

minipill = progestin only

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18
Q

COC pills

A

estrogen and progestin
extended use - 4 years

contraindicated with smokers

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19
Q

patch

A

weekly application for 3 weeks

slight risk of thromboembolism

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20
Q

vaginal ring

A

nuva ring

inserted for 3 weeks and removed for 7 days

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21
Q

depo-provera

A

progestin only

injected every 3 months

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22
Q

long-acting reversible (LARC)

A

intraueterine

nexplanon

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23
Q

IUD

A

Copper - 10 years - non hormonal

Progesterone - Mirena (5 yrs), Skyla (3 yrs), Liletta (3 yrs), Kyleena (3 years)

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24
Q

nexplanon

A 
sits under skin
progestin
good for only 3 years
prevents ovulation, thickens mucus
AE: weight gain, headaches, irregular menses, acne
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25
most effective method of contraception
operative sterilization = vasectomy and tubal ligation
26
after getting vasectomy, how long does it take to clear remaining sperm?
3 months 15-20 ejaculations *no effect on sexual function
27
post coital contraception
sooner taken, the more likely it'll work (within 12 hours) | unlikely to prevent implantation
28
AE of post coital contraception
nausea, HA, irregular bleeding
29
what post coital contraception works by inhibiting or delaying contraception
plan B (w/i 72 hours) - progestin only - interferes with ovulation ella (w/i 5 days) - progesterone modulator yutze method - combined progestin-estrogen pill
30
what post coital contraception prevents fertilization
paraguard (within 5 days) - copper IUD | may affect oocyte and endometrium
31
pregnancy
implantation in the uterine wall of a fertizlied ovum, most fertilized eggs naturally fail to implant
32
What are the three things contraception can block to prevent pregnancy
interference with ovulation, fertilization or implantation
33
abortion
ends an established pregnancy after implantation | miscarriage and therapeutic
34
hormonal contraception
use estrogen/progestone to prevent ovulation and thicken cerivcal mucus
35
do LARCs, plan B and Ella disrupt existing pregnancies
no | plan b and ella work by preventing ovulation
36
t/f: hormonal and copper IUDs work by preventing sperm from reaching and fertilizing an egg
true - copper IUD can prevent implantation of a fertilized egg
37
TORCH
``` Toxicplasmosis Other - hep, sphyllis, Zika, HIV, parvovirus Rubella CMV Herpes ```
38
down syndrome
``` upward slant of eyes epicanthal folds flat facial profile depressed nasal bridge small nose protruding tongue small low set ears short broad hands simian crease hyperflexibility hypotonic muscles ```
39
fetal alcohol syndrome
``` epicanthal folds strabismus ptosis poor suck small teeth abnormal palmar creases irregular hair heart defects ```
40
what could be signs of congenital heart defect
cyanosis within 12-24 hours of birth but normal respiratory signs could be a sign of cardiac issues like ductal dependent lesions
41
choanal atresia
unilateral or bilateral occlusion of posterior nares | bone is blocking 1 or 2 nasal passages
42
cleft palate/lip
cleft palate = opening on roof of mouth | cleft lip = extends from roof of mouth into lip and nasal passage
43
un-repaired trachea espohageal fistula
fistula b/w trachea and esophagus below normal openings to esophagus and trachea and upper part of esophagus dead ends
44
congenital diaphragmatic hernia pre surgical repair
open in diaphragm wall - food contents can go up into chest cavity
45
choanal atresia assessment
cyanosis, retractions, noisy respirations, difficulty breathing during feeding
46
choanal atresia nursing interventions
``` assess patency of nares assist with passing nasal catheter obtain ENT consult maintain resp function head elevation ```
47
cleft palate/lip assessment: what do they swallow a lot of
swallow a lot of air - opening b/w nasal passage and mouth
48
cleft lip and palate interventions
``` burp frequently after each ounce special nipple to use obtain craniofacial/ENT consult clean cleft with sterile water support parental coping place in side lying position but feed in upright position ```
49
un-repaired trachea espohageal fistula assessment
excessive drooling abdominal distension periodic chocking cyanotic episodes
50
un-repaired trachea espohageal fistula nursing
``` prevent aspirations withhold feeding elevate head keep baby calm antibiotics low intermittent suction in pouch ```
51
congenital diaphragmatic hernia pre surgical repair assessment
``` gasping respirations nasal flaring chest retractions barrel chest scaphoid abdomen asymmetric chest expansion diminished/absent unilateral breath sounds ```
52
congenital diaphragmatic hernia pre surgical repair nursing interventions
prepare for intubation high semi fowlers turn to affected side - allows for more lung expansion
53
CPAP
type of mechanical ventilation helps newborns breathe - but newborns are breathing on their own steady flow of air keeps alveoli from collapsing after each breath less hazards than ventilators b/c they don't have enough surfactant
54
CIs for CPAP
choanal atresia cleft palate un-repaired trachea esophageal fistula congenital diaphragmatic hernia pre surgical repair
55
4 types of hyperbili
physiologic - benign breastfeeding jaundice - benign - inadequate fluid intake, self limiting breast milk jaundice - benign - issue with milk composition pathologic
56
phototherapy is required when...
if bilirubin >20mg/dl
57
phototherapy steps
``` remove clothing cover eyes and check every 4 hours check VS every 4 hours cluster care no lotion reposition every 2 hours ```
58
bacterial vaginosis
most prevalent form of vaginal infection a change in normal vaginal flora avoid w/ loose cotton underwear, no perfumes in vaginal flora
59
treatment and diagnose: bacterial vaginosis
whiff test, absence of leukocytes flagyl orally or flagyl/clindamycin cream (avoid alcohol with flagyl) *partners do not need to be treated
60
s/s of bacterial vaginosis
asymptomatic | thin, watery white or grey discharge with odor
61
risks with bacterial vaginosis (7)
increased risk of: - PID - HIV - PTB - PROM - LBW - PTL - PP endometritis
62
nursing interventions: bacterial vaginosis
clindamycin cream: warn shouldn't use condoms and diaphragms for 5 days b/c they interfere w/ treatment integrity promote oral probiotics, vit B complex, avoid excessive products follow up only if symptoms recur
63
tx for UTI
antibiotics void when you need to! empty bladder before and after sex wipe from front to back
64
s/s of UTI
``` asymptomatic dysuria, urgency, frequency fever hematuria chills flank pain ```
65
nursing intervention for UTI
frequent screening and education
66
syphilis tx
test: VDRL (venereal disease research lab), RPR (rapid plasma antigen) benzathine PCN G, Doxycycline/tetracycline
67
s/s of syphilis
chancre (4 weeks) followed by wartlike plaque for 6weeks - 6 months slight fever loss of weight malaise
68
risks w/ syphilis
``` IUGR PTB still birth neonatal death bone and teeth abnormalities ``` infant: snuffles, cataracts, excoriated mouth, rash around mouth and anus
69
nursing interventions w/ sphyllis
testing initially and repeated in third trimester
70
GBS tx
vaginal/anal swab at 35-37 weeks | intrapartal antibiotics: PCN, ampicillin
71
s/s of GBS
asymptomatic
72
risks w/ GBS
UTI miscarriage, PTB, stillbirth, fetal death endometritis, chorioamniotis puerperal sepsis early fetal onset: sepsis, RDS, pneumonia, meningitis late fetal onset: meningitis
73
nursing interventions GBS
identify women at risk, instruct women to inform L&D limit vaginal exam standard precautions
74
chlamydia
most common bacterial sTI - spread through anal, vaginal and oral sex - carried in pre-cum neonate infected during birth process
75
chlamydia tx
endocervical culture, antigen detection azithromycin, amox, doxycycline treat sexual partner!
76
chlamydia s/s
``` asymptomatic mucopurulent (green/yellow) discharge, lower abdominal pain, burning and frequency of urination, friable cervix ```
77
chlamydia risks
``` PID infertility ectopic preg increased risk for HIV fetal: prematurity, conjunctivitis, pneumonia ```
78
nursing interventions w/ chlamydia
screen all sexually active 20-25 year olds screen all pregnant women abstain from sex or 7 days while being treated erythromycin ointment to neonates within 2 hours all medications as prescribed rescreen 3 weeks after regimen
79
Does gonorrhea infect the neonate during the birthing process
Yes
80
gonorrhea tx
endocervical culture ceftriaxone IM plus azithromycin OR plus doxycycline azithromycin PO treat sexual partner!
81
gonorrhea s/s
``` asymptomatic greenish-yellow vaginal discharge dysuria urinary frequency bilateral lower abdominal or pelvic pain ```
82
risks w/ gonorrhea
PID remains localized in urethra and cervix until ROM ophthalmis neonatorum
83
nursing interventions w/ gonorrhea
screen all pregnant women at least once abstain for 7 days erythromycin ointment to neonates within 2 hours rescreen 3 months after treatment
84
PID cause
ascending infection from vaginal and endocervix to the endometrium and fallopian tubes
85
s/s of PID
``` bilateral sharp, cramping pain in lower quadrants fever mucopurulent discharge N/V abdominal tenderness painful sex ``` *can also be asymptomatic
86
nursing interventions PID
partners need to be treated | IUD doesn't need to be removed
87
toxoplasmosis background
cats feces, raw or undercooked meat, unpasteruized goat's milk
88
toxoplasmosis diagnosis and tx
IgM and IgG antibody tests to diagnose amnio to confirm sulfadiazine (might harm fetus) and pyrimethamine (tertatogen)
89
s/s of toxoplasmosis
asymptomatic | mono
90
maternal/fetal risks with toxoplasmosis
miscarrage during 1st trimester still birth birth of child w/ clinical disease, encephalitis, microcephaly, retinochoroiditis survivors = more often blind, deaf w/ severe mental function damage
91
trichomoniasis
protozoan in alkaline env
92
tx and diagnosis for trichomoniasis
elevated ph, positive whiff test flagyl or metronidazole treat both partners!
93
s/s of trichomoniasis
asymptomatic green/grey itchy discharge odor dysuria
94
risks with trich
HIV more easily transmitted PROM PTL LBW
95
nursing interventions with trich
avoid alcohol w/ meds | avoid sex for 7 days
96
crab lice and scabies - where does it come from
shared towels, bed linens and sexual contact
97
tx for crab lice and scabies
permethrin cream to hair, wash after 12 hours or as pill treat partners and family wash all linens
98
s/s of crab lice and scabies
itching | scabies: erythematous, popular lesions or furrows, itching is worse at night
99
candidiasis = yeast infection - cause
``` antibiotics OC or immunosuppressants pregnancy DM increased risk changing vaginal flora ```
100
tx for candidiasis
topically applied 'azole drugs | treatment of male partners not necessary
101
s/s of candidiasis
``` cottage cheese discharge no odor (normal ph) itching swollen labia painful sex pain with urination ``` male: penal rash, itching, swelling, infants: thrush
102
nursing interventions candidasis
education | probiotics
103
hep B background
one of five strands | chronic
104
tx for hep b
test all pregnant women | newborn vaccination
105
s/s of hep b
``` jaundice anorexia n/v malaise fever arthritis (B, C , D) chronic liver disease liver cancer ```
106
When should hep b positive moms get immune globulin
w/i 12 hours of birth of newborn
107
How is parvovirus transmitted and when is the greatest risk during pregnancy?
transmitted via hand to hand contact or droplets | most severe if infection occurs before 20 weeks gestation
108
parvovirus: what do newborns need to be assessed for?
weekly measurements of peak systolic velocity of the middle cerebral artery to detect signs of fetal anemia (transfusion)
109
s/s of parvovirus
myalgia inflammation of nasal membranes, headache, fever, nausea slapped cheek rash on face miscarriage, fetal hydrops, stillbirth, fetal anemia
110
When is the greatest risk for rubella?
1st trimester
111
rubella s/s
asymptomatic | newborn: cataracts, sensorineural deafness, congenital heart defects, CP
112
rubella nursing interventions
vaccinate | avoid pregnancy for 3 months after vaccine
113
What is the most common congenital infection?
CMV
114
How is CMV diagnosed?
cmv in maternal urine | rise in IgM levels
115
T/F: CMV is asymptomatic
True: asymptomatic
116
maternal/fetal risks w/ CMV
``` 10% of newborns have abnormalities hearing loss IUGR/SGA microcephaly hydrocephaly CP intellectual disability anemia hyperbili ```
117
herpes transmission
active primary genital HSV lesion and non-active lesion risk transmitting infection to newborn can be spread by touch
118
tx for herpes
acyclovir, famciclovir, and valacyclovir | C section is recommended for active lesions
119
s/s of herpes
painful lesions in genital area that heal in 2-4 weeks | recurrence w/ stress, menstruation, ovulation, pregnancy and sex
120
herpes maternal/fetal risk | Very similar to CMV!
``` SAB, LBW, PTB 10% of newborns infected have abnormalities hearing loss SGA/IUGR microcephaly hydrocephaly CP mentally disabled anemia hyperbili ```
121
nursing w/ herpes
education: clean, dry, loose clothing, sitz bath, cotton underwear
122
condylomata
genital warts, caused by HPV 6 and 11
123
tx for condylomata
biopsies, gels or creams, cryotherapy | partners don't require tx!
124
s/s of condylomata
asymptomatic | single or multiple soft, graying pink, cauliflower like lesions
125
Which vaccine can prevent condylomata?
HPV vaccine | girls and boys 11-12 years or age or 13-26 year olds
126
How is HIV spread (3)?
acquired through IV drug use, sex w/ infected partner, contaminated blood/fluid (breast milk)
127
tx for HIV
ART for life risk of transmitting HIV drops from 25-1% with ART during pregnancy vaginal ring dapirivine HIV prevention
128
risks w/ HIV (6)
``` amenorrhea early menopause miscarriage reduced fertility PTL/PTD IUGR ```
129
nursing interventions w/ HIV
opt out testing: early adulthood, first prenatal visit, retest in 3rd trimester, rapid testing labor do not go on and off meds check CD4 and VL count throughout pregnancy give IV AZT to mom in labor on time w/ ART avoid CVS, cerclage, amnio, AROM, FSE, SVE hep B vaccine, flu and pneumoia PP infection - poor healing newborns: bathe asap, ART w/i 2 hours, PCR test must be done
130
covid 19 fetal risk
PTB uncommon in newborns with + mothers no risk with breastfeeding
131
nursing interventions w/ covid
vaccines effects on fetus are unclear but offer protection | benefits outweigh risks
132
predictable risk factors for newborns
- low SES of mother and limited access to health care - exposure to environmental dangers - preexisting maternal conditions - maternal factors (i.e. age) - medical conditions r/t pregnancy and complications
133
SGA percentile
below 10th percentile
134
LGA percentile
above 90th percentile
135
symmetric (proportional) IUGR
caused by long term maternal conditions(smoking, high BP, viral, malnutritions, fetal abnormalities) will always be small for age!
136
asymmetrical IUGR
disproportional associated with acute compromise of uteroplacental blood flow, preeclampsia, poor weight gain might catch up once in optimal environment!
137
SGA risk factors: symmetrical (6)
``` smoking, substance abuse high BP, severe malnutrition, chronic intrauterine viral infection, fetal genetic abnormalities, ```
138
SGA risk factors: asymmetric
placental infarcts, preeclampsia, poor weight gain in pregnancy
139
how to diagnose & confirm SGA
diagnose w/ fundal measurement and confirmed with sonogram
140
how to manage SGA during pregnancy
serial nonstress testing (NST) weekly serial biophysical profiles lab assessment - CBC, glucose, cultures for CMV, GBS, toxicology screen for mother, TORCH titer
141
SGA potential problems
- can increase risk for neonatal mortality w/i first 28 days of life - perinatal asphyxia - hypothermia d/t large body surface, lack of SQ tissue and limited brown fat - hypoglycemia d/t increase in metabolic rate in response to heat loss and poor glycogen stores - polycythemia - increased number of RBCs d/t in utero chronic hypoxic stress
142
SGA nursing care
monitor VS; observe for signs of respiratory distress daily weights - assess for changes keep baby warm w/ radiant warmer and polyethylene wrap screen for hypoglycemia = most common complication
143
s/s of newborn hypoglycemia and glucose level
jitteriness, lethargy, poor suck reflex | less than 40 mg/dl plasma glucose level
144
LGA manifestations
- body size usually proportional - macrosomic infant has poor motor skills and more difficulty regulating behavioral states -EDD may have been miscalculated
145
most common risk factor for LGA
most common cause is infant of an uncontrolled gestational diabetic and DM mother
146
other LGA risk factors (2) (baby)
- infants w/ transposition of the great vessels | - Beckwith-Wiedemann syndrome
147
LGA mgmt during pregnancy
NST serial biophysical profiles glucose tolerance tests/monitor blood glucose birth plans education - mom's diet, what to expect after birth
148
LGA potential problems
- birth trauma - fractured clavicle, Erb-Duchenne paralysis secondary to shoulder dystocia - hypoglycemia - polycythemia and/or hyperviscosity - if preterm LGA: RDS - postterm LGA: meconium aspiration
149
LGA nursing care
monitor VS, observe for signs of resp distress monitor weight assess for birth trauma screen for hypoglycemia (jitteriness, lethargy, poor suck reflex) infant should be fed immediately after birth
150
postmaturity syndrome
born after 42 weeks most often due to inaccurate EDD can be SGA, AGA or LGA
151
postmaturity risks for baby (8)
- dystocia - fetal distress during labor - meconium aspiration - decreased amniotic fluid - hypoglycemia from nutritional deprivation and depleted glycogen stores - polycythemia caused by increased production of RBCs in response to hypoxia - congenital anomalies - cold stress
152
postmaturity nursing care
monitor closely during labor for fetal distress hypothermia at birth hypoglycemia - freq blood glucose monitoring and initiate early feeding polycythemia meconinum aspiration -> suction/ ECMO RDS
153
preterm (premature) newborn - how common?
1 in 10 births
154
premature: respiratory
- insufficient surfactant: alveoli collapse with each expiration - inadequate number and maturity of alveoli makes adequate alveolar gas exchange difficult - RDS - signs of resp distress typically develop w/i 1-2 hours after birth
155
nursing interventions for premature respiratory
``` assess respirations oxygen saturation administer oxygen monitor for resp distress suction available ```
156
premature: cardiac
- incomplete mucus coat of pulmonary blood vessels - lowered pulmonary resistance increases left to right shunting - patent ductus arteriosus causes pulmonary congestion, increased resp effort, CO2 retention, and bounding femoral pulses, retractions
157
nursing care premature: cardiac - how often should you take the apical heart rate
apical heart rate for one minute every 1-2 hours
158
premature: thermoregulation (6)
- lack of SQ fat to insulate body - large body surface area in proportion to body weight so more likely to lose heat faster - small muscle mass - absent sweat or shiver mechanism - increased insensible fluid loss - increased risk for hypothermia
159
nursing care: premature thermoregulation
radiant warmer, isolette warm equipment dry immediately assess temp (skin probe)
160
premature: immunological
lack of immunoglobulins from mother - cross placenta during third trimester difficulty localizing infection and poor WBC response increased risk of infection
161
nursing care: premature immunological
monitor for sepsis provide skin care position changes to prevent skin breakdown
162
premature: hematologic/hepatic
- bruises easily r/t fragile capillaries and prolonged pro thrombin time - hyperbilirubinemia r/t immature liver and difficulty eliminating bilirubin released by normal breakdown of RBCs (jaundice) - hypoglycemia - decreased liver glycogen stores - prolonged drug metabolism r/t immature liver - immature production of clotting factors resulting in increased risk of bleeding disorders
163
premature: GI/renal
- aspiration d/t weak suck/swallow reflex until 33-34 weeks gestation, poor gag and cough reflexes - necrotizing enterocolitis (NEC) - unable to concentrate urine effectively increasing risk of dehydration - prolonged drug excretion time r/t immature kidneys
164
necrotizing enterocolitis (NEC)
serious neonatal inflammation of intestines r/t immature GI system and hypoxia
165
nursing care: premature GI/renal
``` gavage feeds = tube feeds until suck or swallow reflex can't breastfeed before 33-34 weeks assess for distention/emesis/dehydration I/O daily weights ```
166
premature: neuromuscular
``` immature control of vital functions increased risk of intraventricular hemorrhage increased risk of apnea poor muscle tone weak or absent reflexes weak, feeble cry ```
167
when is indicated for Mg for fetal neuroprotection (2)
- active labor with cervical dilatation >= 4 cm w/ or w/o PPROM - planned preterm birth for fetal or maternal indications
168
Betamethosone
2 (12.0 mg) doses q 24 hrs before birth | for surfactant
169
surfactant delivery post birth
infasurf (calfactant) administer w/i 30 mins of life! given to gestations earlier than 29 weeks of age
170
when to give respiratory syncytial virus vaccine for preterms
prior to dischrage | monthly during local RSV season
171
do full terms get RSV vaccine
no
172
when does swallow reflex start
35-36 weeks post conception age | when babies can have bottles
173
bottle feedings
15-20 mins | .5-1 oz at a time
174
breast feeding
Need a coordinated suck and swallow first consistent weight gain thermoregulates cup
175
gavage feedings - what do you need to check for before?
check for residual formula/breastmilk in stomach prior to feeding
176
mother w/ controlled diabetes - what does it mean for infant
infants of mother w/ controlled diabetics prior to conception and throughout pregnancy have similar risk as infants of mothers w/o diabetes
177
mother w/ uncontrolled diabetes - infant characteristics
``` ruddy color thick umbilical cord large placenta increased risk of c section risk for LGA ```
178
common complications of infants born to IDM
- higher morbidity and mortality - usually LGA - hypoglycemia (<40 mg/dl; s/s 1-2 hours post birth) - hypocalcemia (tremors) - hyperbilirubinemia (48-72 hrs post birth) - birth trauma - polycythemia - RDS - congenital birth defects
179
IDM nursing care
prenatally: control maternal glucose levels monitor VS observe for signs of resp distress assess for birth trauma screen for hypoglycemia infant should be fed immediately after birth
180
why do you feed newborns born to IDM moms immediately
after cord clamping, blood glucose levels fall and reach nadir 1-2 hours after birth hepatic glycogen depleted if nursing is not established early
181
when to screen for hypoglycemia for newborns born to IDM
hourly for 1st 4 hours then every 4 hours for 48 hours
182
RDS (hyaline membrane disease) - cause
results from deficient/ineffective surfactant
183
when does RDS appear
usually appears during first 24-48 hours; peaks at 72
184
RDS predisposing factors
fetal hypoxia | postnatal hypothermia
185
RDS interventions
keep warm after birth chronic fetal stress --> can lead to surfactant production can be related to BPD
186
risk factors for retinopathy of prematurity
complication of RDS -prolonged exposure to high concentrations of O2 may cause hemorrhage within retina and lead to retinal detachment and loss of vision Other: intraventricular hemorrhage, chronic lung disease, apnea, hypoxia, sepsis, acidosis, multiple gestation, exposure to bright lights, blood transfusions
187
tx for retinopathy of prematurity (ROP)
laser or surgical therapy to reattach retina | ophthalmologist screening
188
intraventricular hemorrhage
complication of RDS - rupture of thin, fragile capillaries within ventricles of the brain leading to increased intracranial pressure - occurs most often in infants less than 1500 grams w/i 72 hours of birth
189
risk factors for IVH
prematurity and hypoxia
190
assessment for IVH
neurologic changes - hypotonia and lethargy, bulging fontanelles, increasing OFC, bradycardia, apnea and head circumference or sometimes there are no symptoms: falling Hct, difficulty maintaining temp
191
bronchopulmonary dysplasia (BPD)
chronic lung disease - lungs stiff, scarred, poor O2 exchange requires mechanical ventilation but can also be a complication of mechanical ventilation
192
O2 therapy support for BPD
``` high frequency ventilation patient triggered ventilation CPAP inhaled surfactant inhaled nitric oxide ```
193
AE of CPAP
nares become excoriated (skin breakdown) | septum disappears but will grow back
194
tx for BPD and side effects of tx
corticosteroids to decrease inflammation and heal lungs large dose tapered over several weeks successful results but may have a range of long term side effects from asthma to lung fibrosis
195
pulmonary interstitial emphysema
overdistention and rupture of distal airways which allows air to leak into connective tissues clinical signs - increased O2 requirements, increased CO2 retention
196
pneumothorax
aveolar rupture from overdistention
197
s/s of pneumothorax
barrel-shaped chest, diminished breast sounds on affected side grunting, cyanosis, tachypnea, retractions, O2 desaturation, hypotension, bradycardia mgmt with needle aspiration
198
necrotizing enterocolitis (NEC)
decreased blood flow and perfusion to intestines b/c hypoxia and hypoxemia at birth; cannot resist bacteria
199
NEC assessment (5)
``` abdominal distension poor feeding vomiting blood in stool decreased bowel sounds ```
200
NEC tx
``` NPO IV fluids parenteral TPN antibiotics until intestines are healed colostomy breastmilk warmed maternal swab for colonization of newborn gut ```
201
meconinum aspiration
d/t stress in uterus color of amniotic fluid will be green, yellow can lead to RDS at birth
202
nursing interventions for meconium aspiration
have low pressure wall suction available possible surfactant therapy maintain adequate oxygenation, ventilation and thermoreg
203
apnea
cessation of breathing for 20 seconds or longer OR for less than 20 seconds w/ cyanosis, pallor and bradycardia bradycardia usually follows apnea!
204
tx for apnea
stimulate respirations w/ gentle tactile stimulation first | if unsuccessful, reposition neonate and support respirations w/ manual resuscitation bag if necessary
205
hyperbilirubinemia - physiologic: when does it appear and what is the cause?
benign never seen during first 24 hours, usually appears by 3rd day d/t immature liver that cannot manage additional RBCs at birth or RBCs from bruising d/t traumatic birth
206
pathologic hyperbili: when does it appear and what can be the cause?
before 24 hours and persistent after day 7 severe bruising can be d/t blood dyscrasia ABO and Rh incompatibility --> leads to anemia can be d/t infection
207
kernicterus
bilirubin of 25 mg/dl or more stains brains cells, causes brain cell death, CP and epilepsy
208
Who gets cord bili blood testing?
for all preemies
209
nursing care for hyperbili
check mom's Rh status --> rhogam w/i 72 hrs of birth phototherapy frequent feedings to clear bili IV albumin, IGG or IGM to help excrete bili blood exchange transfusion - 3cc in and out bilimeterus check coombs test
210
at what age should children have appropriate names for body parts
4-5 years
211
how often should you have CBE 18-40?
q3 years
212
how often should you have CBE 40-65 yo?
annually
213
how often should you have mammograms 45+
annual
214
over 30, how often should you have PAP/HPV test?
PAP q 3 years | HPV q 5 years
215
what age does colorectal cancer screening begin
46
216
what age do you discontinue mammograms and colorectal screening
75
217
how to assist pts in self-discovery in the growing years (6-18)
vulvar and breast self assessments understand physiology discuss kegels know normal vaginal mucous/ fluid
218
cycle length of menarche
lasts from first day of one menses to first day of the next | 28-30 days (can vary from 21-35)
219
what would indicate an abnormal cycle
blood flow of greater than 80 ml/cycle
220
how often should you change pads during period
3-5 hours | should assess if supersaturates a maxipad every 1-2 hours for 2-3 days
221
how often should you change tampons
3-6 hours avoid super tampons wash hands pre and post
222
TSS - cause
staph auereus | etiology: non removal of tampons, diaphragms, cervical caps
223
s/s of TSS
``` fever, low BP, body rash, NVD severe myalgia inflamed vaginal mucous membranes elevated BUN and liver function tests low platelets ```
224
how to treat TSS
IV antibiotic and vasopressors
225
primary amenorrhea
no menses by 16 or w/in 4 years of breast development
226
secondary amenorrhea
menses established for >3 months and then ceases
227
how to examine/test amenorrhea
pelvic exam MRI serum prolactin (low or high), fSH (elevated, TSH levels (can lead to primary)
228
dysmenorrhea causes
can be primary or secondary | endometriosis, PID, cervical stenosis, uterine fibroids, ovarian cysts, tumors, IUD
229
how to treat PMS
restrict alcohol, chocolate, caffeine, nicotine, animal fats, salt and sugar aerobic exercise, COC, NSAIDs vitamin B6 (50-100 mg daily), calcium (1200 mg daily), Mag (400mg daily), vitamin E (400 units) black cohosh, ginger, red raspberry leaf, evening primose oil, soy
230
what can lead to elective terminations
a failure of fertility mgmt or contraception | lack of knowledge or access to BC
231
vacuum aspiration
up to 13 weeks | outpatient, light anesthesia, 10-15 mins
232
D&C
13-22 weeks inpatient deep anesthesia
233
laminaria
medical abortion | insert into vagina, herb that dilates cervix and causes cramping
234
methotrexate IM injections
medical abortion | halts embryo growth
235
Misoprostol vaginal suppository: what is it used for and how long does it take
in 5-7 days causes uterine contraction | medical abortion
236
when can medical abortions be done
before 9 weeks
237
RU486 - when can you take
70 days after 1st day of last LMP
238
what is RU486
2 drug procedure 1.mifepristone to block progesterone (3 pills) 2. methothrexate + misoprostol - 36-48 hours later to cause contractions return to check in 2 weeks
239
AE of RU486
``` N/V/D headaches bleeding cramping hot flashes mouth sores ```
240
BSA
breast self awareness | know what is normal
241
HPV vaccine
to prevent HPV and gential herpes 3 injections over 6 months gardisil
242
for multiple sexual partners, how often should gyn screening occur
every 3 months
243
gyn history
``` menarche menstrual pattern PMS and dysmenorrhea sexual history and risks pregnancy/contraception medical/surgical history ```
244
GYN exam
general health physical exam CBE abdominal palpation for uterus and ovaries internal speculum exam to visualize cervix bi-manual exam to assess ovaries/masses rectal exam-guiac test for GI bleeding
245
endometriosis
tissue grows outside of the uterus b/w 20-45 years of age pelvic pain, painful intercourse, infertility
246
tx for endometriosis
combined OCs, progestins, testosterone, GnRH analogs
247
how to dx endometriosis
laparoscopy
248
endometriosis tx
tissue removal w/ laser | hysterectomy = severe cases
249
PCOS: s/s
7% incidence - menstrual irregularities - hyperandrogenism - obesity - hyperinsulinemia - infertility - depression
250
tx PCOS
oral contraceptives to help regulate hormones and menses
251
ovarian cancer: how common and what are the signs
5th most common cancer in women no screening tool! mimics GI and bladder disorders - bloating fullness, pelvic/GI discomfort, pain that doesn't fluctuate and lasts for more than 3 weeks, dysfunctional vaginal bleeding
252
risk factors for ovarian cancer
age, hx of breast cancer, BRCA 1/2 and family history
253
endometrial cancer: signs
slow growing | abdominal bleeding post menopause, vaginal discharge, enlarged uterus
254
risks for endometrial cancer
``` ERT nulliparity PCOS late menopause HTN DM ```
255
cervical cancer: signs
slow growing painless vaginal postmenstrual and post coital bleeding foul smelling discharge pelvic pain
256
risks for cervical cancer
HPV early first sex smoking multiple sex partners
257
cervical screening/tx
``` Bethesda system colposcopy LEEP cryosurgery laser conization - remove cone of cervix ```
258
causes of pelvic floor issues
cystocele - bulge of bladder into uterus rectocele - condition in which the tissue wall b/w rectum and vagina weakens uterine prolapse
259
rectocele
rectum blaoons into vagina
260
uterine prolapse: cause and s/s
d/t trauma of pregnancy | manifests as dragging sensation in groin and backache over sacrum
261
cause of cystocele and how to tx
wall b/w bladder and vagina weakens bladder in anterior vagina stress incontinence tx: kegels, vaginal pessary or rings
262
what can contribute to benign breast disorder
caffeine chocolate tobacco
263
malignant breast disease: prevalence
1 in 8 | mostly occurs over age 50
264
menopause
absence of menses for 1 full year usually b/w 45-58 estrogen levels drop
265
perimenopause
menstrual irregularities duration of 5-8 years decreased libido, vaginal lubrication pregnancy can still be an issue
266
menopause characteristics
``` endometrium thins, breast atrophies increased vaginal infections b/c of decreased secretions pubic hair thins hot flashes psychological ajdustement osteoporosis CV risk b/c decreased HDL levels lack of sleep ```
267
hormone therapy for menopause
- estrogen therapy (only for women w/ hysterectomy) - estrogen/progesterone therapy - oral, transdermal, gel, lotion, mist, cream, vaginal ring - adding testosterone may help with decreased libido
268
complementary therapy for menopause
isoflavone (soy) - estrogen like qualities, do not use if a cancer history black cohosh, red clover, ginseng, kava, DHEA
269
osteoporosis risk factors
family hx | decreased estrogen levels
270
osteoporosis prevention
``` Ca and Vit. D weights and balance training no smoking moderate alcohol fall prevention full range of meds! ```
271
hysterectomy
remove all repro organs
272
dilation and curettage
scrape uterus
273
uterine abalation
used for excessive blood loss | remove endometrial lining
274
saplingectomy
remove tubes | can be tx for ectopic preg
275
oophorectomy
remove ovaries
276
vulvectomy
remove labia, clitoris, etc. | can be for cancer or precancer
277
causes of vulvar lesions
cancer bartholin gland cyst (drainage, antibiotics) lichen sclerosus (peri and post menopausal, tx with antihistamines)
278
Cycle of abuse
1. Tension building phase 2. Acute battering incident (violence) 3. Tranquil phase (honeymoon phase)
279
Characteristics of tranquil phase
If women is abused, women generally are not interested in seeking help but the batterer is more open to get help if offered
280
When are abused party most likely to seek help
Acute battering violence phase
281
Victim/survivor characteristics
May believe themselves to be subservient Personal feeling of poor self worth Co-dependency.- responsible for needs of others Perception that abuse is the one in need they have a problem and need help
282
Abuser characteristics
``` Low self esteem Insecure, powerlessness Poor verbal skills Problems with abandonment, intimacy Loses temper easily Unusual jealousy Violence is acceptable Rigid idea of male/female/partner roles Substance abuse complications ```
283
Elder abuse
- Over age of 65 - More women than men - Domestic abuse, institutional abuse, self neglect
284
Other forms of abuse
``` Stalking Cyberstalking Sexual harassment Assault Date rape Homophobia ```
285
Rape trauma syndrome acute phase
Shock, disbelief Embarrassment Wants revenge Suppress emotions but may also cry, sleep disturbances
286
Rape trauma syndrome: outward adjustment phase
Look composed outwardly Might refuse to discuss Might deny need for counseling Might seek out security measures (i.e. self defense)
287
Rape trauma syndrome: Reorganization
Emotional distancing Risky sexual behaviors Phobias Nightmares Urge to talk about or resolve feelings or can remain silent Might cycle back b/w acute and outward adjustment phase
288
Rape trauma syndrome: integration and recovery
Safe Know to blame assailant Advocacy stage Might relapse (not linear)
289
Strategies to decrease violence
Education: build healthy relationships, parenting classes Identify families at risk Support groups Improve self worth Communication action Law/policy - violence against women act of 1994
290
Nursing plan: violence
``` Open body language Acknowledge and support Focus on strengths Avoid blame Be patient Assist in problem identification and viable solutions Assist with an exit plan Do not pressure Do not put at increased risk ```
291
Inequality
Unequal access to opportunities
292
Equality
Evenly distributed tools and assistance
293
Equity
Custom tools that identify and address inequality
294
Justice
Fixing the system to offer equal access to both tools and opportunities
295
what % of women are carriers of GBS
10-40%
296
what can GBS lead to
endometritis, amniotis, UTI
297
how do you get GBS
during birth process or through ascending genital tract infection
298
How is CMV transmitted
birth process or placenta or breastmilk and saliva
299
What does UTIs increase the risk for as it relates to birth?
increased risk for premature birth, IUGR
300
Is breastfeeding contraindicated with a herpes lesion
breastfeeding = CI w/ breast lesion
301
When is a C section not indicated for HIV infected mom
C section not indicated for RNA < 1000 copies
302
Characteristics of moms with LGA babies
-mothers of LGA babies tend to be heavier, taller, older and of greater parity
303
Concerns with post maturity syndrome
mortality rate is 2-3 x higher than for term infants decreased placental function impairs oxygenation and nutrition transport placenta ages and calcifies
304
Hyperbili: erythroblastosis fetalis
Increase in immature RBCS | Pathologic
305
Hyperbili: hydros fetalis
Pathological Destruction of RBCS Severe anemia - could lead to death

Mother Baby (3 decks)

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