ob final Flashcards

Question

Postpartum DVT: Signs and Symptoms of Thrombophlebitis: Inflammation

Answer 1

●Signs and symptoms: redness, warmth, pain, tenderness, edema, fever

●Interventions: elevate, heat, pain meds, SCDs

●Can progress to superficial thrombophlebitis, DVT, pulmonary embolism (PE)

Answer 2

●Similar signs & symptoms as above

●Similar treatment with addition of strict bedrest and initiation of anticoagulant

Answer 3

●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

Answer 4

●Nasal flaring

●Grunting

●Retractions (use of intercostal or subcostal muscles “drawing in” of tissue between ribs)

Answer 5

●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

Answer 6

ASSESS!!!

then…call for help.

Answer 7

●Mild TTN occurs 1-2 hours post-birth●

Shows signs of respiratory distress

●May require supplemental oxygen

●Usually resolves within 24 hours

Answer 8

●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

Answer 9

●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

Answer 10

●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

Answer 11

●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

Answer 12

ambient temperature in newborn care areas should range between 22° and 26° C (72° to 78° F)

the humidity between 30% and 60%

Answer 13

●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

Answer 14

●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

Answer 15

●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

Answer 16

●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

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

Answer 17

●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)

Answer 18

●bilirubin toxicity when bilirubin levels are high enough to cross the blood-brain barrier

○Signs and symptoms: lethargy, irritability, seizures, coma, death

Answer 19

●irreversible long-term effects of bilirubin toxicity

○Signs and symptoms: hypotonia, hearing loss, delayed motor skills, cerebral palsy

Answer 20

adjective used to describe being affected by jaundice

Answer 21

○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

Answer 22

○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)

*more severe type of jaundice

Answer 23

○Occurs at 2-5 days after birth○Hyperbilirubinemia occurs due to lack of effective breastfeeding (breastfeeding itself is not a cause)

Answer 24

○Occurs at 5-10 days after birth○Rare, unknown cause but likely factors in breast milk decrease ability to excrete unconjugated bilirubin

Answer 25

●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

Answer 26

●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

Answer 27

-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%”

Answer 28

●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.

Answer 29

failure of testes to descend; more common in preemies)

Answer 30

urethra is below tip of penis)

vs

(urethra is above tip of penis)

Answer 31

overlapping of cranial bones during birth to allow passage through the birth canal → variations in shape of head

Answer 32

● “caput” or “cone head” caused by sustained pressure during birth → compression of vessels → ↓ venous return → edema

Answer 33

●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

Answer 34

can also occur and is rare but more severe; often occurs from the shearing forces of an operative delivery

Answer 35

Forceps

Hyperbiliriumia

Answer 36

○Tremors or jitteriness are easily elicited by motions or voice and cease with gentle restraint of the body part, whereas seizure activity continues.○Passive flexion and repositioning of the tremulous extremity reduces or stops the movement.○Seizure activity is unique in that it is associated with ocular changes (eyes deviating or staring) and autonomic changes (apnea, tachycardia, pupil changes, increased salivation) *test blood to see if jitteriness is from low blood sugar

Answer 37

●Apgar scoring●Vital signs q30●Newborn assessment q30●I&Os●Thorough newborn assessment●Administration of erythromycin and vitamin K●Assistance with first feed●Security tags●Education

Answer 38

0-3 severe distress

4-6 moderate difficulty

7-10 adapting

Answer 39

0: absent

1: Slow< 100/min

2: > 100/min

Answer 40

0: absent

1: Slow, weak cry

2: Good cry

Answer 41

0- flaccid

1- Some flexion of extremities

2- Well flexed

Answer 42

0-Blue, Pale

1- Body pink, extremities blue

2- Completely Pink

Answer 43

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

Answer 44

●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

Answer 45

●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

Answer 46

●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

Answer 47

●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

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

Answer 48

Use a fan on on for more circulation in the room and a pacifier when sleeping
sleep in parents room for at least 6 months to a year

Risk factors: parent/drug alcohol use, sleeping on stomach, formula fed, bed-sharers

Answer 49

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

Answer 50

●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!!!

Answer 51

●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

Answer 52

At 24 hours

Answer 53

●A leading cause of neonatal morbidity and mortality●Symptoms often discrete and nonspecific○Important to catch early

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

Answer 54

●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

Answer 55

Nursing interventions:

●Decrease stimuli, consolidate care, ensure nutrition/hydration, promote parent-infant attachment when appropriate (skin-to-skin) and breastfeeding, facilitate self-soothing, swaddle/rock

Answer 56

●Symptoms: tachycardia, fever, diarrhea, projectile vomiting, nasal congestion, hyperactivity, irritability, excessive crying, perspiration, feeding issues

Answer 57

●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

Answer 58

●Most often occurs due to isoimmunization (usually Rh incompatibility)

○Less often associated with ABO incompatibility

●Most common reason for pathologic jaundice

Answer 59

Sinousiodal

Answer 60

●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

Answer 61

Yes, but not as severe as symptoms

Answer 62

●“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

Answer 63

Nursing interventions:

●Observe for signs and symptoms of hypoglycemia, cardiac conditions, and respiratory distress; monitor blood sugars per hypoglycemia protocol

Answer 64

● autosomal recessive enzyme deficiency unable to break down phenylalanine requiring strict dietary changes

Answer 65

●variety of causes; requires thyroid hormone replacement

Answer 66

autosomal recessive leading to 1 of 3 enzyme deficiencies requiring specific dietary changes

Answer 67

●Lung disease characterized by immature lung development●Almost exclusive to preterm infants; insufficient surfactant is main cause

Answer 68

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

Answer 69

●After establishment of effective respirations, warmth for premature infants is next priority●Goal is a neutral thermal environment until able to control their own thermal stability○Incubator, radiant warming panel, open bassinet with cotton blankets, plastic wraps/bags

Answer 70

○Some babies ready as soon as 28 weeks○Suck/swallow coordination doesn’t occur until 32-34 weeks (not synchronized until 36-37 weeks)

Answer 71

●Therapeutic communication, anticipatory guidance for delivery, allow patient and family to lead but provide boundaries, give options

Answer 72

assess risk factors, educate on process, diagnoses, and after care; aid in decision making; arm precautions (avoid blood pressures, IVs on arm of mastectomy)

Answer 73

●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

Answer 74

●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!

Answer 75

●Menopause: the last menstrual period

○Cannot be confirmed until one year of no menses○Marked by a single event

Answer 76

●Postmenopause: begins one year after the last menstrual period

○Longest phase

Answer 77

●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

Answer 78

●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

Answer 79

●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 Jarisch-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

Answer 80

●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

Answer 81

●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

Answer 82

●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

Answer 83

●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

Answer 84

●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

Answer 85

●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

Answer 86

●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

Answer 87

●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

Answer 88

●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

Answer 89

Abdominal pain

Ches Pain

Headaches

Eye problems

Severe leg pain

Answer 90

●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

Answer 91

●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

Answer 92

●Arm implants●Intrauterine devices●Perfect use = typical use because no room for “user error” ~99%

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

Answer 93

●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

ob final Flashcards

(117 cards)