Test 3 Flashcards
(162 cards)
1
Q
Leading cause of maternal morbidity/mortality
A
Postpartum Hemorrhage (PPH)
2
Q
Blood loss during hemorrhage is usually….
A
Underestimated
3
Q
Risk factors for postpartum hemorrhage include…
A
- Induction
- C/S
- Multiple births
- Over-distension of the uterus
4
Q
Postpartum hemorrhage in a client who just delivered vaginally is considered blood loss greater than…
A
500 mL
5
Q
Postpartum hemorrhage in a client who just delivered by C/S is considered blood loss greater than…
A
1000 mL
6
Q
Patients who lose 1 L of blood or more are at risk for developing…
A
Shock
7
Q
The three major causes of early PPH are
A
- Uterine atony
- Lacerations/trauma
- Hematoma
8
Q
Uterine atony risk factors… (4)
A
- Overdistention of the uterus
- Dysfunctional or prolonged labor
- Induction/augmentation
- Analgesics/anesthesia
9
Q
First thing you do with a postpartum hemorrhage…
A
Fundal massage!
10
Q
Pitocin, Methergine, and Prostaglandins (carboprost/hemabate) are medications used to treat…
A
Postpartum Hemorrhage
11
Q
Why should the nurse avoid giving hemobate to patients with asthma?
A
Can cause bronchospasms
12
Q
Biggest difference between laceration bleeding and hemorrhage is…
A
Fundal firmness! (Fundus will be firm and contracted if laceration bleeding)
13
Q
A patient complaining of persistent perineal/rectal pain after delivering may be experiencing…
A
Hematoma (s/s are subtle, be aware of any small complaint)
14
Q
Nursing interventions for a postpartum hematoma…
A
Cold compress (decreases swelling and discomfort)
15
Q
Major cause of late PPH
A
Retained placental fragments
16
Q
Normally, it should take no longer than…. to deliver the placenta
A
30 minutes
17
Q
An abnormal placental adherence that does NOT involve the muscle is known as…
A
Accreta
18
Q
An abnormal placental adherence that DOES involve the muscle (usually bladder wall) is known as…
A
Percreta
19
Q
A patient presents postpartum with a fever of 101 that started 24 hours after her delivery and has lasted for 2 days. She is exhibiting signs of…
A
Puerperal Infection
20
Q
Signs/symptoms of a localized (wound) puerperal infection include…
A
- Redness of skin edges
- Edema
- Firmness of wound
- Tenderness
- May have purulent drainage
21
Q
Signs/symptoms of a generalized puerperal infection may include…
A
- Fever, Chills
- Malaise, Lethargy
- Foul or purluent lochia
- Uterine tenderness
- Cramping, abdominal pain
- Subinvolution
- Increased WBC count
22
Q
An extended infection that includes the connective tissue of the broad ligament is known as…
A
Parametritis (Pelvic cellulitis) - If left untreated can turn into peritonitis
23
Q
An inflammatory infection of the breast
A
Mastitis
24
Q
A major risk factor for mastitis is…
A
Sore, cracked nipples (portal of entry for bacteria)
25
Signs/symptoms of mastitis include...
1. Sudden onset of flulike symtpoms (fever, chills, body ache, HA, malaise)
2. Localized pain/tenderness
3. Hot, reddened area
26
A women experiencing mastitis should continue breast feeding. True or False?
True (want to promote frequent emptying)
27
Treatment for mastitis includes...
1. Antibiotics and analgesics
2. Warm compresses before feeding
3. Frequent nursing and good breast support
4. Rest
5. Fluids and nutrition**
28
Major defining characteristic that distinguishes baby blues for postpartum depression
Baby blues resolves by day 10
29
Signs/symptoms of postpartum depression get... overtime
Worse (onset and progression may be gradual)
30
The onset of postpartum psychosis is usually within...
3 months (1st 3-6 weeks)
31
Major predisposing factors to postpartum depression are...
1. Prenatal depression and/or anxiety
| 2. A history of depression
32
Important education to women and their partners after delivery...
Difference between baby blues and postpartum depression (and when to seek professional help)
33
Any loss or neonatal death up to 1 month of age
Perinatal loss
34
A preterm infant is defined as...
Any infant born prior to 38 weeks that is physically and neurologically appropriate for the assessed gestational age
35
Physical signs/symptoms of a preterm infant include...
1. Decreased muscle tone
2. Thin skin and low fat
3. Absent plantar creases (before 32 weeks)
4. Flat nipples
5. Vernix and lanugo
6. Flat and pliable pinna of ear
7. Easily exhausted with a weak cry
8. Increased respiratory efforts (due to decreased levels of surfactant)
9. Increased risk for hypothermia
36
Most accurate way of determining gestational age
Physical assessment
37
Signs/symptoms of pain in a newborn
1. Changes in HR
2. Increased respiration
3. Decreased O2 saturation
4. Grimace and rigidity
38
Failure of the newborn to establish continuous respiratory effort
Perinatal asphxia
| Nursing management: Resuscitation
39
Mild degree of respiratory distress
Transient tachypnea of the newborn (TTN)
| Nursing management: Supportive
40
Inhalation of meconium stool from amniotic fluid that occurs inutero and may be a possible cause of intrauterine distress
Meconium Aspiration Syndrome
| Nursing managment: Intensive care situation
41
Insufficient production of surfactant that can be caused by a stressful intrauterine environment
Respiratory Distress Syndrome (RDS)
42
At risk infants for the development of RDS are..
1. Pre-term
2. Asphyxia
3. Diabetic babies (insulin disrupts pulmonary maturation)
43
The signs/symptoms of RDS...
Present within 1 hour, worsen over 48-72 hours, and can result in the reopening of the ductus (return to fetal circulation)
44
Management of RDS includes...
1. Use of exogenous surfactant
2. Oxygen and ventilation
3. Correcting the metabolic and respiratory acidosis
4. Suctioning
5. Thermoregulation
45
Difference between respiratory distress syndrome and respiratory distress
Syndrome lasts longer
46
Visual impairment of preterm infants that results from hemorrhage to fragile vessels leading to scarring/retinal detachment
Retinopathy of Prematurity (ROP)
47
ROP can be caused by...
1. HIGH*/low O2
2. Acidosis
3. Prolonged ventilation
4. Sepsis and shock
48
Serious intestinal infection in preterm infants that can be caused by sepsis, polycythemia, maternal cocaine use, hypoxia, or shock
Necrotizing Entercolitis (NEC)
49
Signs/Symptoms of NEC include...
1. Lethargy
2. Poor feeding, decreased BS
3. Abdominal distention
4. Bloody stools
5. Apnea, bradycardia
6. X-ray verification of free air in the abdomen
50
Management of an infant with NEC includes...
1. Bowel rest (TPN)
2. Antibiotics
3. Respiratory monitoring
4. Gastric decompression
51
Number 1 nursing intervention for parents of a preterm infant...
Encourage parental attachment
52
An infant that is small for gestational age (SGA) will weigh less than...
2500g (5lb8oz)
53
Complications for a SGA infant include...
1. Asphyxia
2. Hypoglycemia
3. Inadequate thermoregulation
4. Polycythemia
5. Altered nutrition
54
An infant that is large for gestational age (LGA) will weigh more than...
4000g (8lb13oz)
55
Complication for a LGA infant include...
1. Hypoglycemia
2. Birth trauma/injuries (shoulder dystocia, fractures of clavicle or skull, brachial plexus, facial nerve injury)
3. Seizures
4. Bruising
56
Why do postterm infants have an increased rate of mortality?
Decreased placental functioning
57
Development of polycythemia in a newborn is due to..
Poor intrauterine oxygenation (fetus produces more erythrocytes to compensate)
58
Distinguishing feature between pathological and physiological jaundice is...
Time of onset (pathological jaundice appears in the 1st 24 hours)
59
Bilirubin levels in a newborn are monitored related to...
Age
60
Bilirubin encephalopathy
Kernicterus
61
Testing of maternal blood during pregnancy for antibodies against fetal blood
Indirect Coombs
62
Cord blood testing
Direct Coombs
63
Rh negative mothers are given RhoGAM within 72 hours of delivering a Rh positive baby because...
it will halt antibody formation for future pregnancies
64
Neonatal infection (Sepsis Neonatorum) is more commonly caused by...
GBS and E.Coli
65
Horizontal transmission
Moves from placenta to fetus
66
Vertical transmission
Moves up the vagina
67
Signs/Symptoms of Neonatal Infection
* Early signs may be subtle
1. Temperature instability (SUB NORMAL readings)
2. Tachypnea, apnea
3. Pallor/cyanosis
4. Tachycardia, bradycardia
5. Decreased BP
6. Vomiting, hypoglycemia
7. Lethargy, irritability
8. Bulging fontanelle
68
Syndrome seen in prenatal opiate or cocaine exposure
Neonatal Abstinence Syndrome
69
How do you test an infant for Neonatal Abstinence Syndrome?
Urine sample (PUC)
70
An infant who is irritable with a high pitched cry, normal blood glucose, has vomiting and diarrhea, and poor feeding whose mother tested positive for opiate dependency is exhibiting signs of...
Neonatal Abstinence Syndrome
71
Nursing care for an infant exposed to drugs
1. Focus on feedings (small, frequent), rest, and parental attachment
2. Decrease environmental stimuli
3. Swaddle and rock vertically
4. Utilize PUC to diagnose and screen infant
72
Teratogenic effects of alcohol on a fetus include...
1. Prenatal and postnatal growth restriction
2. Decreased attention and memory; mental retardation
3. Facial anomalies (flat midface, low set ears, cranial anomalies)
73
When the uterus displaces into the vaginal canal
Uterine prolapse
74
Major sign/symptom of uterine prolapse
Backache
75
Biggest potential issue with uterine prolapse
Infection
76
A weakness between the vagina and bladder
Cystocele
77
A weakness between the vagina and rectum
Rectocele
78
Prolapse of the upper portion of the vaginal wall
Enterocele
79
An abnormal opening caused by gyn procedures, childbirth, or carcinoma
Fistula
80
With a vesico-vaginal fistula.... leaks into the vagina
Urine
81
With a recto-vaginal fistula... leaks into the vagina
Stool
82
Most common BENIGN tumor
Leiomyoma (Fibroid)
83
Presence of normal endometrial tissue in sites outside the endometrial cavity
Endometriosis
84
Signs/Symptoms of Endometriosis
Cyclic pain
INFERTILITY
Dyspareunia
85
Danocrine is a synthetic androgen that inhibits the anterior pituitary used to treat...
Endometriosis (promotes ovarian suppression and pseudomenopause)
86
Side effects of Danocrine include...
1. Hirsutism
2. Weight gain
3. Acne
87
Nursing management for endometriosis
1. Educate about side effects of medications
2. Comfort measures
3. Psychological support (pain, infertility, sexual difficulties)
88
Infection of the pelvic cavity caused by untreated GC, Chlamydia or by having multiple partners
Pelvic Inflammatory Disease (PID)
89
A patient complaining of abdominal pain, dyspareunia, post-coital bleeding, ADNEXAL TENDERNESS, fever, and discharge is exhibiting symptoms of...
Pelvic Inflammatory Disease
90
Long term complications of PID
Infertility and ectopic pregnancy due to the formation of scar tissue
91
Benign endocrine disorder characterized by insulin resistance, androgen excess, and unbalanced hormone levels
Polycystic Ovarian Syndrome (PCOS)
92
Clinical manifestations of PCOS
1. Amenorrrhea
2. Acne
3. Hirsutism
4. Obesity
5. Alopecia
6. Acanthosis nigricans
93
Cause of benign cyst formation in PCOS
Increased LH and decreased FSH causes anovulation
94
Treatment for PCOS includes...
1. Exercise/weight loss
2. Diet to help improve glucose tolerance; metformin
3. Birth control pills
95
Cause of cervical cancer
Human Papiloma Virus (HPV)
96
Risk factors for the development of cervical cancer
1. Low socioeconomic status
2. Early sexual activity*
3. Multiple partners*
4. Smoking
5. Exposure to DES in utero
97
Signs/Symptoms of cervical cancer include...
1. Intermenstrual bleeding
2. Thin, watery discharge
3. Post-coital bleeding
98
A patient experiencing papular warty lesions, pain, post-coital bleeding and pruritis is exhibiting signs of...
HPV
99
Low-risk strains of HPV responsible for genital warts
Strains 6 and 11
100
High-risk strains of HPV responsible for cervical cancer
Strains 16 and 18
101
Vaccine for HPV
Gardisil
102
Most common GYN cancer
Endometrial cancer
103
Biggest sign of endometrial cancer
Unexplained peri/post menopausal bleeding
104
Risk factors for endometrial cancer include...
1. Unopposed estrogen replacement (if taking estrogen, need progesterone to balance!)
2. Obesity (fat makes estrogen)
3. Nulliparity, low parity
4. Diabetes, HTN
5. Menopause
6. Chronic anovulation
7. PCOS
105
Patient education in the prevention of endometrial cancer
1. Be sure to take progestin in hormone replacement therapy
2. Weight management
3. Early evaluation of abnormal bleeding
106
Risk factors for Ovarian Cancer
1. Age
2. Genetics
3. High fat diet**
4. History of other cancers
5. Nulliparity**
6. Infertility
107
Why is ovarian cancer so difficult to diagnose?
Often asymptomatic in early stages and there is no screening test
108
Common complaints with undiagnosed ovarian cancer
Indigestion and GI symptoms
109
Patient education for all forms of reproductive cancer
1. Prevent, screen, detect
2. Symptomology
3. Treatments
4. Wound management
5. Bowel and bladder elimination
6. Self-care management
7. Signs of infection
8. Sexual dysfunction
110
Leading cause of PID
Gonorrhea
111
Penicillin is more commonly used to treat what STD?
Syphilis
112
Most common STD
Chlamydia
113
Most important part of treatment for chlamydia
Treat partner as well, and abstain from intercourse during treatment
114
Metronidazole (Flagyl) is used to treat which STD?
Trichomoniasis
115
Important education point when treating a patient with Flagyl
Avoid alcohol
116
A patient complaining of malodorous (fishy) smelling discharge may be exhibing symptoms of...
Bacterial vaginosis (BV)
117
Complication in pregnancy caused by BV
Preterm labor or premature rupture of membranes
118
Patients with a positive history of herpes simplex virus are treated with what starting at 36 weeks gestation
Valtrex
119
Leading cause of death in women
Cardiovascular disease
120
Why is height an important components of a patient's physical assessment?
It helps to determine bone density
121
Precursor to osteoporosis
Osteopenia
122
BMI to be considered overweight
25-29.9
123
BMI to be considered obese
30-39.9
124
These types of exercises will help to increase bone density
Resistance and weight training
125
RDA of calcium for women aged 24-50 and for women 50-64 who ARE taking HRT
1000 mg/day
126
RDA of calcium for women aged 50+ who are NOT taking HRT
1500 mg/day
127
RDA of fiber
25-35 grams/day
128
Nurses role in women's health
1. Assessment/history
2. Identification of risk factors
3. Counseling/emotional support
4. Client education
5. Advocacy
6. Health promotion
129
Highest incidence of benign breast disorder in women of childbearing age
Fibrocystic Change
130
Signs/Symptoms of Fibrocystic Change
1. Pain/tenderness
2. Lumpiness in BOTH breast
3. S/S usually appear 1 week before menses and subside 1 week after menses end
131
Conservative management approach to fibrocystic change
1. Diet modification (decreased Na, decreased caffeine)
2. Supportive bra
3. Vitamin E
132
Medications used to treat fibrocystic change are ones that...
counteract the hormonal influence (decrease effects of estrogen)
133
Nursing implications with any benign breast disorder
1. Risk factors
2. Lifestyle characteristics
3. Events surrounding the mass
4. How much time has elapsed between discovery and care seeking
5. Pain relief strategies
6. Encourage discussion of feelings
134
Risk factors associated with the development of malignant breast disease
1. High fat diet
2. Obesity with menopause
3. Race
4. Sedentary lifestyle
5. "menstrual markers" (early menarche, late menopause)
6. Daily alcohol use
7. Nulliparty/first pregnancy after 30
8. Estrogen or HRT
9. BRCA gene mutations
135
Most common form of breast cancer
Invasive ductal carcinoma
136
Late finding of invasive ductal carcinoma
Peau d'orange (orange peel skin)
137
Most common symptom of breast cancer
Nontender, nonmobile palpable lesion
138
Over half of breast cancer lesions are found...
In the upper, outer quadrant
139
Why should the arm of the side where lymph nodes were removed in breast cancer treatment never be placed in a dependent position?
Increased risk of lymphedema development
140
Anastrozole (arimidex) is used to treat...
Postmenopausal ER+ tumors (breast cancer)
141
The ideal contraceptive is...
1. Safe
2. Easily available
3. Economical
4. Acceptable
5. Easy-to-use
6. Promptly reversible
142
The "right" contraceptive product is defined as...
The lowest dose of hormone needed to prevent ovulation, has the least side effects, and is the least harmful
143
How does hormone based contraception work?
It INCREASES estrogen and progesterone which DECREASES GnRH, FSH, and LH, and results in no ovulation.
144
Physical responses to hormone based contraception
1. Decreased tubal transport of ovum
2. Thickening of the cervical mucosa (more difficult for sperm to penetrate)
3. Decreases endometrial build-up (prevents implantation of pregnancy)
145
Potential side effects of increased estrogen levels
1. N/V
2. Dizziness, visual changes
3. Edema, swelling of breasts
4. Leg cramps
5. Chloasma (pigment changes)
6. Increased BP, vascular headache
146
Potential side effects of decreased estrogen levels
1. Early spotting
2. Hypomenorrhea
3. Nervousness
4. Atrophic vaginitis (leads to dyspaerunia)
147
Potential side effects of increased progestin
1. Increased appetite
2. Tiredness, depression
3. Breast tenderness
4. Vaginitis
5. Hirsutism
6. Postpill amenorrhea
148
Potential side effects of decreased progestin
1. Late spotting/breakthrough bleeding
2. Heavy flow with clots
3. Decreased breast size
149
Contraindications to hormone based contraception can be grouped into the ACHES acronym which stands for...
```
A - Abdominal Pain
C - Chest Pain
H - Headaches/Neuro S/S
E - Eye Problems
S - Severe Calf Pain
```
150
Which oral contraceptive is closes to the natural cycle?
Multiphasic
151
What is the cause of toxic shock syndrome (TSS)?
Things being left too long in the vagina (i.e. diaphragm).
| Need to educate patients regarding signs/symtpoms
152
The PAINS acronym is used to describe the early IUD warning signs. It stands for...
```
P - Period late; abnormal spotting
A - Abdominal pain
I - Infection
N - Not feeling well
S - String missing
```
153
Important education points for a client utilizing an IUD are...
1. Checking placement
| 2. Signs/symptoms of an ectopic pregnancy
154
A patient utilizing the fertility awareness method of birth control should be taught that thermal shift occurs...
After ovulation due to an increase in progesterone
| Fertile period is the day of increased temperature, continuing for 3 consecutive days of increase
155
A patient utilizing the Billings method of birth control is checking...
Character of cervical mucosa (fertile phase = egg whites)
156
Primary infertility is defined as...
Couple has never previously conceived
157
Secondary infertility is defined as..
Couple may have conceived before, but are unable to conceive after a previous pregnancy
158
Fertility drug that can be given to either men or women
Clomid
159
Why is Clomid given to men?
To increase sperm count
160
The minimum number of sperm needed to achieve a pregnancy
20 million/mL with normal mobility
161
A women's fertility is dependent on....
1. Regular production of normal ova
2. Open path from cervix to fallopian tube
3. Uterine endometrium that supports implantation
162
Most important portion of a female infertility assessment
History and physical! (Need to know previous menstrual pattern)
