MODULE 4: Pregestational Problems Flashcards
STD & STI & SUBSTANCE ABUSE
1
Q
Each year the new cases of STD’s estimates to about
A
9 million
2
Q
Each year the new cases of STD’S occurs on ages
A
15-24
3
Q
Highest STD rates occurs in what age group in the country
A
Sexually active youth
4
Q
Pregnant women with STD’s are at greater risk of what
A
miscarriage and premature delivery
5
Q
In some cases of pregnant women with STD’s, they can also transmit the infection to which individuals
A
Babies
6
Q
HIV cases per day in year 2008
A
1
7
Q
HIV cases per day in 2010
A
4
8
Q
HIV cases per day in 2012
A
9
9
Q
HIV cases per day in 2014
A
17
10
Q
HIV cases per day in June 2016
A
26
11
Q
Risk Factors of STD’s
A
a. lower socio-economic status
b. lower educational level
c. sexual activity with multiple partner
d. unsafe sexual intercourse
12
Q
Sexually Transmitted Infections
A
a. Candidiasis
b. Trichomoniasis
c. Bacterial Vaginosis
13
Q
Affects the skin, skin of the vagina, the penis, and the mouth
A
Candidiasis
14
Q
A yeast infection and a thrush
A
Candidiasis
15
Q
An STD’s that can also infect the bloodstream or internal organs such as liver and skin
A
Candidiasis
16
Q
Where does Candida albicans thrive
A
Glycogen (high in estrogen = high in glycogen levels)
17
Q
Oral contraceptives
A
alters vagina making glycogen rich
18
Q
Destroys normal flora
A
Cephalosporin
19
Q
Vaginal discharge of candidiasis
A
Cream cheese
20
Q
Etiologic Agent of Candidiasis
A
Candida albicans
21
Q
Candidiasis can cause
A
a. newborn candidiasis
b. oral thrush (white patches on tongue)
22
Q
Risk factors of candidiasis
A
a. Pregnancy
b. Oral contraceptives
c. Antibiotic therapy
d. Immunosuppression
e. Diabetes mellitus
23
Q
Assessment for Candidiasis
A
a. Reddened vulva
b. Pruritus
c. White patches on the vaginal wall
d. Thick cream-cheese like vaginal e. discharges
e. Pain during coitus
f. Painful urination
24
Q
Screening and Diagnosis
A
a. complete history taking
b. physical exam
c. KOH wet smear
d. checking of vaginal pH
25
Checking of vaginal PH
bluish discoloration in nitrazine paper
26
Oral contamination of candidiasis can lead to
Oral thrush (small patches on tongue)
27
Medications used for Candidiasis
a. Application of an over-the-counter antifungal cream (Monistat) for 7 days
b. Oral Fluconazole
28
Symptoms of Candidiasis
a. thick yellow vaginal discharge
b. pruritus
29
What organism is Candida albicans
Fungus
30
Management of Candidiasis
a. Sitz bath
b. Not wearing under pants
31
How is Sitz Bath being done
a. Add 1.2 to 1 tablespoon (5mL to 15 mL) of baking soda or 1 to 2 teaspoons (5mL to 10mL) of salt to the water in the plastic sitz bath
b. Swirl the water until the baking soda or salt dissolves
c. Carefully sit down in the plastic sitz bath and soak your bottom area for 10 to 15 minutes
32
A common cause of this STD's is vaginal infection and discharge
Trichomoniasis
33
Trichomoniasis
a. Incubation period 4 - 20 days
b. Common cause is vaginal infection and discharge
c. Inflammation of the vulva and vagina
d. Irritation and itching in vaginal area
e. Profuse greenish-yellow discharge with foul odor
34
Assessment: Trichomoniasis
a. Vaginal irritation
b. Frothy (mabula) white or grayish-green vaginal discharge
c. Reddened upper vagina
d. Pruritus
35
Medical Management of Trichomoniasis
a. discuss the importance of partner treatment
b. discuss the sexual transmission of this disease
c. Metronidazole (anti-fungal) - given on second trimester onwards
36
Trichomoniasis characteristics
a. Inflammation of the vulva and vagina
b. Irritation and itching in vaginal area
c. Profuse greenish - yellow discharge with foul odor
d. Frosty white or grayish - green vaginal discharge
37
Etiologic Agent of Trichomoniasis
Trichomonas Vaginalis
38
Effects of Trichomoniasis to fetus / pregnancy
a. Preterm labor
b. Premature Rupture of Membranes (PROM)
c. Post-cesarean infection
d. Medical Management: Metronidazole (anti-fungal)
39
A common vaginal infection that happens when some normal bacteria that lives in the vagina overgrows
Bacterial Vaginosis
40
Absence of lactobacilli
Bacterial Vaginalis
41
Common vaginal infection that happens when some normal bacteria that lives in the vagina overgrows
Bacterial Vaginalis
42
Nitrogen-containing compounds produced by bacterial metabolism with strong odors
Vaginal amines
43
Etiologic agent of Bacterial Vaginalis
Gardnerella Vaginalis
44
Bacterial vaginalis effect on vagina
Acidity of vagina increases (alkalotic)
45
Screening and Diagnosis
a. complete history taking
b. Report fishy odor & increase vaginal discharge
c. normal saline smear
46
Normal Saline Smear
a. 10% Potassium Hydroxide
b. Only seen through microscope
c. Check Vaginal secretions for pH and amine odor
47
Signs and symptoms of bacterial vaginalis
a. gray and has a "fishy" or "musty" odor vaginal discharge
b. pruritus
48
Bacterial Vaginalis has been related with what conditions and complications of pregnancy
Gynecologic
49
Effects to fetus / gynecologic conditions and complications of pregnancy due to bacterial vaginalis
a. Pelvic inflammatory disease (PID)
b. Post hysterectomy vaginal cuff cellulitis
c. Endometritis
d. Amniotic fluid infection
e. Preterm delivery, preterm labor
f. Premature rupture of the membranes (PROM)
g. Spontaneous abortion
50
Medical Management of Bacterial Vaginalis: topical
a. metronidazole (flagyl) - 0.75 percent vaginal gel
b. clindamycin - 2 percent vaginal cream
51
Medical Management of Bacterial Vaginalis: Cream
a. Metronidazole - 500 mg orally twice daily (5 day therapy)
b. clindamycin 300 mg orally twice daily (5 day therapy)
52
Benefits of medical management at twice daily
a. At twice-daily, 5-day therapy of vaginal metronidazole had a reported cure rate of 75–81 percent, while treatment with clindamycin cream was reported to resolve 82–96 percent of cases of BV
53
Considered medication that is safe in pregnancy
There is no evidence that metronidazole is teratogenic or mutagenic
54
Assessment : Chlamydia
a. heavy, grayish-white discharge
b. pruritus
c. common complications; cervicitis, urethritis, vaginitis, PID
55
Etiologic agent of the STI Chlamydia
a. Chlamydia Vaginalis
b. Chlamydia trachomitis
56
In Asia, rates among pregnant women tend to be much higher for up to
a. Up to 17% in India
b. Up to 26% in rural Papua New Guinea
57
Screening and Diagnosis
a. Complete history taking
b. Physical exam with symptoms
c. Cervical culture during 1st prenatal visit, if positive, repeat at 36 weeks
58
Cervical culture during 1st prenatal visit, if positive, repeat at 36 weeks
a. Use sample urine if cervical swab is unavailable
b. To prevent conjunctivitis and pneumonia
59
Signs and Symptoms of Chlamydia
a. heavy, gray - white discharge
b. common clinical manifestations include; cervicitis, urethritis, vaginitis, pelvic inflammatory disease
60
Risks of Chlamydia
a. Studies have shown that infants born through an infected birth canal have a 60-70% risk of acquiring the infection
b. In approximately 25.50% of exposed infants, conjunctivitis will develop; In 10-20% of the infants, pneumonia will develop
c. In pregnant women, Chlamydia infections can lead to ectopic pregnancy, preterm premature rupture of membranes (PPROM), and premature delivery
61
Medical Management of Chlamydia
a. Tetracycline & Doxycyline (non-pregnant state)
b. amoxicillin or erythromycin (pregnant) orally single dose
c. azithromycin (pregnant) 1 g orally
62
Doxycycline
a. teratogenic
b. mostly used in non-pregnant women
63
Effects : Chlamydia
a. Ectopic pregnancy
b. Preterm birth
c. Premature Rupture of Membranes (PROM)
d. Amniotic fluid infection
e. Premature delivery
64
A sexually transmitted infection characterized by progressive stages that can lead to serious complications
Syphilis
65
Etiologic agent of Syphylis
treponema pallidum
66
Syphilis
a. Etiologic Agent: Treponema pallidum
b. Incubation Period: 10 - 90 days
c. Early Pregnancy - intact cytotrophoblast layer of the chorionic villi
d. 16th to 18th week
67
Research on Syphilis
a. Studies of pregnant women in Africa have revealed rates of 17.4% in Cameroon, 8.4% in South Africa, 6.7% in Central African Republic and 2.5% in Burkina Faso
b. In the Western Pacific, there are relatively high cases in the South Pacific (8%), 4% in Cambodia and 3.5% in Papua New Guinea
68
Signs and symptoms of Shyphilis
a. Primary stage
b. Secondary stage
c. Latent stage
d. Tertiary stage
69
Primary stage of Syphilis
small, hard based chancre or sore
70
Secondary stage of Syphilis
a. skin rashes
b. loss of patches of hair
c. malaise
d. fever
71
Latent stage
asymptomatic for a few years to several decades, positive VDRL test
72
Tertiary stage
a. gumma formation (rubbery mass of tissue)
b. affect major organs (heart, nervous system)
73
Diagnostic Procedure for Syphilis
a. Patients suffering from syphilis produce antibodies that react with cardiolipin antigen (present in beef meat) in a slide flocculation test, which are read using a microscope
74
Screening and Diagnosis of Syphilis
a. VDRL test
b. Repeated test when close to term (8th month pregnancy) - if exposure is concern
c. infant born to a mother with syphilis
75
Infant born to a mother with syphilis
positive for 3 months even though disease is treated during pregnancy
76
Effects of Syphilis to Fetus
a. Spontaneous abortion
b. Still born infant
c. Premature labor
d. Congenital syphilis (enlarged liver & spleen, skin lesion, rashes, pneumonia, hepatitis)
e. Hira, S. K. (1988) found out that pregnancy outcomes of the 81 seropositives before intervention showed 11 abortions, 12 preterm deliveries, 9 low birth weight babies, 11 stillbirths, and 4 congenital syphilis (58% of syphilitic pregnancies).
77
Medical Management for Syphilis
a. Benzathine penicillin G (pregnancy)
b. Procaine penicillin, intramuscular, 750 mg daily for 10 days
c. Erythromycin 500 mg four times a day should be given for 14 days (allergy to PenG)
d. Azithromycin 500 mg should be given daily for 10 days (allergy to PenG)
78
Jarish - Herxcheimer reaction
a. It is causes due to sudden destruction of spirochetes
b. May last about 24 hours
79
Signs and symptoms of Jarish - Herxcheimer reaction
a. hypotension
b. fever
c. tachycardia
d. muscle aches
80
Congenital Anomalies
a. Extreme rhinitis (sniffles)
b. Syphilitic rash (face, soles of the feet, palm of hands)
c. Hutchinson’s teeth
d. Interstitial keratitis
81
Assessment: Syphilis
a. History Taking for Multiple partners, unprotected intercourse and drug related risks
82
Nursing Interventions: Syphilis
a. Facilitate Learning
b. Provide Social and Emotional Support
c. Promote Self care
83
Promote Self care
Emphasize that douching is contraindicated unless prescribed
84
A sexually transmitted disease affecting the mucous membranes of the genitals, rectum, and throat, and potentially leading to severe complications if untreated.
Gonorrhea
85
Can be concurrent with chlamydia
Gonorrhea
86
Research on Gonorrhea
a. In the Western Pacific in the 1990s, the highest prevalence rates (3% or greater) were in Cambodia and Papua New Guinea
b. Other areas such as China, Vietnam and the Philippines had rates of 1% or less
87
What is the Etiologic agent of Gonorrhea
Neiserria Gonorrhoeae
88
Mode of transmission of Neiserria Gonorrhea
a. Genital to genital
b. Anal to genital
c. Oral to genital
d. Vagina to rectum
89
Assessment of Gonorrhea
a. Yellowish to greenish vaginal discharge
b. Inflamed Bartholin’s glands
c. Painful Bartholin’s glands (painful during palpation)
90
Screening and Diagnosis
a. Urine culture
b. Vaginal culture
c. Urethral culture (especially in males)
d. Anal culture
e. Oral culture (newborn baby born to gonorrhea mother)
91
Effects of Gonorrhea to fetus / pregnancy
a. Severe eye infection (fetus)
b. Blindness
c. Endocervicitis
d. Intrauterine growth restriction
e. Premature Rupture of Membrane (PROM)
f. Preterm birth
g. Maternal postpartum sepsis
92
Medical Management of Gonorrhea
a. Oral cefixime (Suprax)- 400 mg PO once
b. Ceftriaxone (Rocephin)- 125-250 mg IM once
c. common side effects - nausea and vomiting
93
Most recent drug suggestion
Azithromycin
94
Common side effects of Oral Cefixime and Ceftriaxone
Nausea and Vomiting
95
Etiologic Agent of Herpes Genitals
a. Herpesvirus hominis type 2
b. Herpes simplex virus 2 (HSV-2)
96
Mode of transmission of herpes genitals
shin to skin contact / direct contact
97
Shin to skin contact / direct contact
a. Break in the skin or mucous membrane
b. Incubation period of 3-14 days
98
Assessment: Herpes Genitals: Primary Stage (week 1)
a. Pinpoint vesicles (lesion) from the external genitalia
b. Flu like symptoms (increased temperature
c. Profuse vaginal discharge
d. Intense pain on contact with clothing or acidic urine
99
Screening and Diagnosis
a. Appearance of the lesions
b. Pap smear
c. Vesicle culture
d. ELISA
100
Medical Management: Herpes Genitals
a. Acyclovir (Zovirax) - antiviral that inhibits replication of herpetic viruses
b. Topical imiquimod (Aldara) - vesicular lesions of pt
c. Foscarnet (Foscavir) - prescribed for resistant lesions
d. Valacyclovir (valtrex) - used as a preventive measure to help limit the disease spread
e. Sitz bath (TID)
f. Use of condoms
g. Annual Pap Tests
101
Effects: Herpes Genitals
a. Transmitted across the placenta
b. Transmitted to the newborn at birth (primary/secondary active lesions in the vagina)
c. Congenital herpes - severe systemic infection (fatal)
d. CS Birth is scheduled (active lesions)
Vaginal Birth (no lesions)
102
Has no cure
Herpes Genitals
103
A virus that attacks the immune system, specifically CD4 cells, weakening the body’s ability to fight infections
HIV
104
HIV
a. can lead to aids, but not all cases
105
Most advanced stage of HIV infection, characterized by severe immune suppression and increased susceptibility to opportunistic infections and certain cancers
AIDS
106
Characteristics of HIV / AIDS
a. AIDS is increasing more rapidly among women, as it is now the fourth leading cause of death among women aged 25- 44
b. For women in their reproductive years (15–44), HIV/AIDS is the leading cause of death and disease worldwide, while unsafe sex is the main risk factor in developing countries
107
Etiologic agent of HIVf transmission
Human retrovirus
108
Mode of transmission of HIV
a. intimate sexual contact
b. Parenteral exposure to blood, body fluids and blood-containing products
c. Perinatal transmission
109
Stages of HIV Infection
a. Initial Invasion
b. Seroconversion
c. Asymptomatic period
d. Symptomatic period
110
Initial Invasion
a. flu-like symptoms
b. Mononucleosis-like or influenza-like symptoms
111
Seroconversion
a. converts from having no HIV antibodies in her blood serum to having HIV antibodies
b. usually happens 6 weeks - 1 year after exposure
112
Asymptomatic period
weight loss and fatigue (3-11 years old)
113
Symptomatic period
a. opportunistic infections occur like oral and vaginal candidiasis, kaposi sarcoma, herpes complex, pneumocystis carnii
b. These opportunistic infections are the ones that causes death to HIV patients (especially pneumonia)
114
Diagnostic Procedure for HIV
a. ELISA (Enzyme-Linked Immunosorbent Assay)
b. Western blot analysis (for confirmation)
c. Possible Diagnosis: Risk for infection related to dysfunctional immune system
115
Nursing Management for HIV
a. aseptic technique - hand washing and gloves; reverse isolation
b. administration of medications as prescribed
c. provide health education
d. Goal: Maintain CD4 cell count >500 cells/mm3
e. cesarean delivery
116
Maintain CD4 cell count >500 cells/mm3
a. Administer oral zidovudine along with ritonavir (Norvir) or indinavir (Crixivan)
b. If PCP develops, a woman is treated with TMP-SMZ (Bactrim, Septra), pentamidine (Pentam) is the DOC in nonpregnant women
c. Platelet transfusion if close to birth
117
Administration of medications as prescribed
acyclovir; antiretroviral therapy
118
Provide health education on
a. breastfeeding
b. protected sexual activity
119
Nursing Management for STD
a. assessment
b. diagnosis
c. interventions
120
Assessment
a. history taking
121
What to include in history taking
a. multiple partners
b. unprotected sexual intercourse
122
Diagnosis
knowledge deficit
123
Interventions
a. discuss the causes of STD: multiple partners
b. teach about proper hygiene: perineal washing
c. provide care with a non-judgmental attitude
124
Etiologic agent of Papilloma Infection (HPV infection)
human papilomavirus
125
Genital warts
a. External vulva
b. Vagina
c. Cervix
d. anus
126
Assessment : Papilloma Infection
a. Profuse vaginal discharge
b. Itching
c. Dyspareunia
d. Post-coital bleeding
e. Bumps on vulva
f. Cauliflower like
127
Screening and Diagnosis : Papilloma Infection
a. Physical exam
b. Pap Smear
c. Histological evaluation biopsy of specimen (most definite)
128
Histological evaluation biopsy of specimen (most definite)
Tutusukin yung wart and kukunin yung tissue as specimen
129
Medical Management: Papilloma Infection
a. Removal of warts
b. Administer vaccine (Gardasil)
c. Keep the area clean and dry
d. Wear cotton underwear and loose-fitting clothes that decrease friction and irritation
130
Removal of warts
a. Application of podophyllin (Podofin) - small lesions
b. TCA/BCA applied to lesions weekly for pregnant women
c. Laser therapy, cryocautery, knife excision - large lesions
131
Administer vaccine (Gardasil)
a. Recommended for teenage girls (9 - 14 years old) in 3 doses
b. Reduces incidence of HPV and cervical cancer
132
Pregnancy and HPV
a. Increase of HPV lesions
b. Ulcerated and Infected lesions
c. Foul vulvar odor
133
Classifications of Substance Abuse
a. alcohol
b. cocaine and crack
c. marijuana
d. MDMA (Ecstasy)
e. Heroin
f. Methadone
134
Characteristic on Alcohol abuse
a. Woman may experience withdrawal seizures in the intrapartal period as early as 12-48 hours after she stops drinking
b. Delirium tremens may occur in the postpartum period
c. newborn may suffer a withdrawal syndrome
135
Effects of Alcohol on mother
a. Malnutrition - folic acid and thiamine deficiency
b. bone marrow suppression
c. Increased incidence of infections
d. Liver diseases
136
Effects of Alcohol on Fetus
a. Fetal Alcohol Syndrome (FAS)
b. Physical and mental abnormalities
c. Intoxicate the infant
d. Inhibit the maternal letdown reflexetal
e. Fetal mental retardation
f. Fetal growth restrictions
137
Nursing intervention for abuse of alcohol
a. sedation to decrease irritability and tremors
b. seizure precautions
c. intravenous fluid therapy for hydration
d. preparation for an addicted newborn
e. breastfeeding is contraindicated
138
Sedation to decrease irritability and tremors
Take caution on fetal depression
139
Breastfeeding is contraindicated
Alcohol is excreted in the breastmilk
140
Alcohol abuse of mother can lead to physical abnormalities
a. small head
b. undeveloped pinna (outer ear)
c. short nose
d. missing groove above lip
e. pointed, small chin
f. small eye openings
g. flat face
h. thin lips
141
Characteristics of Cocaine abuse
a. Placental vasoconstriction decreases blood flow to the fetus
b. Feeling of euphoria and excitement
c. Usually followed by irritability, depression, pessimism, fatigue, and addiction
d. Cocaine metabolites may be present in the urine of the pregnant woman for 4-7 days after use
e. Cocaine crosses into breast milk
142
How does cocaine abuse lead to placental vasoconstriction
stimulates sympathetic nervous system
143
What happens after placental vasoconstriction occur due to cocaine abuse
a. reduced blood flow to the fetus
b. decrease oxygen and nutrient supply to fetus
c. fetal growth restriction
d. low birth weight
e. development issues
f. increased risk of placental abruption
g. preterm birth
h. placental complications
144
Take caution on pregnant women with;
a. extreme irritability
b. vomiting
c. diarrhea
d. dilated pupils
e. apnea
145
Signs and symptoms of cocaine abuse
a. mood swings
b. appetite changes
146
Withdrawal symptoms on cocaine includes;
a. depression
b. irritability
c. nausea
d. lack of motivation
e. psychomotor changes
147
Effects of cocaine on pregnant women
a. seizures
b. hallucinations
c. pulmonary edema
d. cerebral hemorrhage
e. respiratory failure
f. heart problems
g. spontaneous abortion
h. abruption placentae
i. preterm birth
j. stillbirth
148
Effects of cocaine on fetus
a. IUGR (intrauterine growth restriction)
b. small head circumference
c. cerebral infarction
d. altered brain development
e. shorter body length
f. malformation of the genitourinary tract
g. APGAR score (low/poor)
149
Effects of cocaine on newborn
a. exposed in utero may have neurobehavioral disturbances
b. irritability
c. exaggerated startle reflex
d. labile emotions
e. sudden infant death syndrome
150
It is a CNS depressant narcotic
Heroin
151
What Heroin Abuse do
alters perception and produces euphoria
152
An addictive drug that is administered IV
Heroin
153
Abuse of Heroin on pregnant women would lead to
a. increased incidence of poor nutrition
b. iron deficiency anemia
c. pre-eclampsia
154
Abuse of Heroin on fetus would lead to
a. increase risk for IUGR)
b. meconium aspiration
c. hypoxia
155
Abuse of Heroin on newborn would lead to
a. restlessness
b. shrill
c. high-pitched cry
d. irritability
e. fist sucking
f. vomiting
g. seizures
156
When does withdrawal symptoms typically occur when withdrawing from heroin
appear within72 hours
157
Characteristics of Methadone drug
a. most commonly used therapy for women dependent on opioids
b. blocks withdrawal symptoms
c. reduces or eliminates the craving for narcotics
d. it crosses the placenta
e. prenatal exposure
158
What will happen when pregnant women withdraws from methadone
Newborn may experience withdrawal symptoms that are often severe and longer lasting
159
Abuse of methadone would lead to
Prenatal exposure
160
Prenatal exposure
a. reduced head circumference
b. lower birth weight
161
Nursing Diagnosis for Methadone
a. Imbalanced nutrition: less than body requirement related to inadequate food intake secondary to substance abuse
b. Risk infection related to use of inadequately clean syringes and needles secondary to IV drug use
c. Risk for ineffective health maintenance related to a lack of information about the impact of substance abuse on the fetus
162
Planning and Implementation on Methadone Abuse
a. prevention on substance abuse during pregnancy
b. provide information about the relationship between substance abuse and existing health problems
c. preparation for labor and birth should be part of prenatal planning
d. preferred methods of pain relief
163
Preferred methods of pain relief
a. psychoprophylaxis and regional blocks (epidurals)
b. local anesthetics (pudendal block, local infiltration)
164
Evaluation on Methadone abuse
a. the women is able to describe the impact of her substance abuse on herself and her unborn child
b. the women gives birth to a healthy infant
c. the woman accepts a referral to social services for follow - up care after discharge
