Unit 3 exam Flashcards
1
Q
infants of diabetic mothers r/o
A
- congenital anomalies
- cardiac anomalies
- IUGR
- respiratory distress
2
Q
neonate hypoglycemia onset
A
•BS < 40 in term •BS < 25 in preterm •jittery •RDS •lethargy •poor suck •seizures *w/in 1-3 hrs after birth
3
Q
polycythemia
A
- Hct > 65%
- inc. blood viscosity -> poor O2
- inc. RBC hemolysis -> jaundice
- inc. r/o cephalhematoma/bruising
4
Q
early onset neonate bacterial infection
A
- congenital
- rapid progression (1-2 days)
- hypothermia common s/sx
- GBS most common
5
Q
late onset neonate bacterial infection
A
- acquired
* late progression (1-2 wk)
6
Q
drug/etoh neonate effects
A
- pre-term
- placental abruption
- LBW
- small head
- high pitched cry
- IUGR/UPI
- exaggerated reflexes
7
Q
pathologic jaundice
A
•appears w/in first 24 hrs •r/t excessive RBC destruction -blood incompatibility •bill high and stay high *get stat bill if suspected
8
Q
physiologic jaundice
A
- appears after first 24 hrs
- benign
- resolves by day 4
9
Q
omphalocele
A
•intestines stick out of umbilicus are COVERED by thin layer of tissue
10
Q
gastroschisis
A
•intestines stick out of umbilicus UNCOVERED
11
Q
when is suck-swallow-breath reflex mature
A
•34 wks
12
Q
readiness to PO feed
A
- rooting
- sucking
- gag
- RR < 60
- tolerate being held
13
Q
preterm expected UOP
A
•1-3 mL/kg/hr
14
Q
assessing preterm renal fxn
A
- UOP
- Na, hct, BUN, SG
- weight
- turgor/edema
- anterior fontanelle
15
Q
preterm hematologic issues
A
- inc. cap friability
- inc. clotting time
- dec. erythropoiesis
- dec. RBC life
- dec. blood vol.
16
Q
bronchopulmonary dysplasia
A
•O2 still required 28 hrs after birth or 36 wks post conceptual age
17
Q
necrotizing enterocolitis (NEC)
A
•accumulation of gas in submucosal layers of bowel wall
•causes necrosis, perforation, and sepsis
•abd. distension, bloody stool, feed retention
*2 wks after birth
18
Q
post-mature characteristics
A
- old placenta -> dec. O2/nutrients
- meconium aspiration
- polycythemia
- hairy
- long nails
- dry, peeling skin
19
Q
small for gestational age (SGA)
A
•< 5.5 lbs in term
20
Q
asymmetric growth restriction
A
•head and length unaffected
•weight disproportional
•recover w/ nourishment
*r/t MID PG complications
21
Q
symmetric growth restriction
A
•weight, length, head all affected
•may have long-term growth issues
*r/t EARLY PG complications
22
Q
NIPS
A
•neonatal infant pain scale
- facial expression
- crying
- arm movement
- leg movement
- state of arousal
- hormone levels
23
Q
CRIES
A
•neonatal pain scale Crying Requires oxygen Increased VS Expression Sleepless
24
Q
diagnostic testing
A
•evaluates for and tells of there IS a genetic/congenital issue
25
screening
•evaluates RISK FOR an issue
26
antepartum testing
* evaluates fetus AFTER problem is detected
| * Ex: NST, kicks, U/S
27
1st trimester U/S
```
•TV or TA
•dates (CRL)
•# fetus
•heart activity
*1-12
```
28
2nd trimester U/S
```
•TA
•fetal anatomy/viability
•sex @ 18 wk
•PTL assessment
*13-27
```
29
3rd trimester U/S
```
•fetal well being
•BPP
•AFI
•placental location/grading
•growth (IUGR)
•presentation
•PTL assessment
*28-birth
```
30
nuchal translucency
* 1st tri screening done 10.5-13.5 wks
* assessing for downs
* contra: pt refuse; past dates
31
quad screen
1. MSAFP
2. hCG
3. Estriol
4. Inhibin A
32
maternal serum feroprotein screening (MSAFP)
```
•2nd tri screening done 16-20 wks
•high = ONTD
•low = downs
*requires followup (don't repeat)
*false + if multiple gest, dates off
```
33
amniocentesis in 2nd tri
* after 14 wk
| * detects karyotype
34
amniocentesis in late 3rd tri
* detects fetal lung maturity (2:1)
| * detects Rh incompatibilities
35
amniocentesis risks
* SAB
* stillbirth
* ROM
* PTL
* abruption
* fetal injury
36
chronic villus sampling
* 1st tri alternative to amniocentesis
* test fetal portion of placenta
* genetic testing @ 10-12 wks
* r/o SAB/limb loss
37
percutaneous umbilical blood sampling (PUBS)
•18 wks = genetics
•3rd tri= blood tranfusion for hemolytic dz
•r/o cord lac/hematoma/ROM/PTL/infection
*often in OR b/c may have to get baby out ASAP
38
reactive NST
•< 32 wk = 10x10
•> 32 wk= 15x15
•mod. variation and NO decals
*indicates CNS fxn
39
non reactive NST
```
•minimal variation
•no accels
•+ decels
•requires CST or BPP
*may have to induce
```
40
CST
* induction of ctx to assess FHR in response to stress
* more invasive (IV) than NST and BPP
* contra in preterm and anything that would lead to PTL
41
negative CST
•no decels
•3 ctx in 10 min
•reassurance that fetus will survive labor
*normal
42
postive CST
•late decels in > 50% ctx
•indicates UPI
•requires induction or C/S ASAP
*abnormal
43
biophysical profile (BPP)
•U/S and EFM to assess
1. FHT
2. breathing
3. amnio vol.
4. movement
44
normal BPP scorring
•8/8 = normal (didn't do NST)
•8/10 = normal and non-reactive NST
•10/10 = normal and reactive NST
*no evidence of UPI
45
equivocal BPP
* 6
| * repeat in 24 hr
46
abnormal BPP
* < 6
| * induce/C-section ASAP
47
polyhydramnios
```
•AFI > 25
•d/t
-NTD
-GI obstruction
-twins
-hydrops
-DM
-congenital anomalies
```
48
risks r/t polyhydramnios
* cord prolapse
* PROM
* unsuccessful labor
49
oligohyramnios
```
•AFI < 5
•d/t
-renal issue
-PROM
-post-dates
-UPI
```
50
risks r/t oligohyramnios
* cord accident
* fetal malformation
* hypoplastic lungs
51
fetal kick count instructions
* eat/relax
* should feel 10 movements in 2 hrs
* if no move in 12 hrs -> further testing
52
PTL clinical characteristics
* b/t 27-37 wks GA
* > 6 ctx/hr
* cervical change
* vag bleeding/discharge
53
PTL interventions
* prevention/early detection key
* tocolytic
* steroids
* bed/pelvic rest
54
tocolytic drugs
```
•MgSO4
•terbutaline
•nifedipine
•indomethacin
*promote uterine relaxation
```
55
low birth weight (LBW)
* ANY baby born < 2500 g, regardless of GA
| * usually caused by IUGR
56
PROM
•premature rupture of membrane 1+ hr before onset of labor
57
PPROM
•premature rupture of membrane 1+ hr before onset of labor AND GA < 37 wks
58
risks r/t PPROM and PROM
* infection
* cord prolapse
* fetal abnormalities (skeletal; lung)
59
s/sx cord prolapse
•severe variable decels
•fetal bradycardia
•see cord
*ALWAYS vag exam if suspected
60
hypotonic labor vs. hypertonic labor
•hypo is no fetal distress
•hypo may require augmentation
•hyper may require uterine resuscitation
*both involve NO cervical change
61
causes of passageway (tissue) obstruction
•full bladder (#1)
•cervical edema
•HPV
*avoided by emptying bladder and not pushing until 10 cm
62
shoulder dystocia interventions
* McRoberts- knees to chest
* Gaskin- all 4s
* Zavanelli- push head in & C/S
63
uterine rupture vs. uterine dehiscence
* dehiscence is incomplete rupture w/ no pain or fetal distress
* rupture is complete and requires resuscitation & C/S
64
uterine resuscitation
* pt on side
* stop pit
* open main fld. line
* O2 @ 10L
* vag exam (r/o prolapse)
* Brethine (uterine rlx)
65
tachysystole
•hyper stimulation of uterus
•ctx > 90 sec
•> 5 ctx in 10 min
*causes late decel; loss of variability
66
when uterine resuscitation may be necessary
* tachysystole
* uterine rupture
* hypertonic ctx
67
pitocin admin
* ALWAYS IVPB on pump
* attach close to insertion site
* start low and slow
68
Bishop score
```
•estimates how successfully labor can be induced
•based on:
-dilation
-effacement
-station
-consistency
-position
```
69
readiness for induction
•Bishop of 9+ for nulls
•Bishop of 5+ for multip
*if not ready (low score) may have to cervical ripen
70
amniotomy
•AROM
•fetal station MUST be low
*WONT shorten labor
71
excessive fld following amniotomy indicates...
* polyhydramnios
| * high fetal station (DONT ambulate)
72
important after episiotomy
•NEVER give enema/suppository
| *do give PO stool softeners
73
fibrocystic changes
* benign breast d/o
* bilateral pain/tenderness
* occurs prior to menopause
* tx: diuretics; NSAIDs; no caffeine; reduce Na+
74
tamoxifen
* selective estrogen receptor modulator (SERM)
* breast cancer hormone adjuvant
* blocks estrogen
* ONLY works on estrogen-receptive tumors
* SE similar to menopause
75
candidiasis
* vaginal yeast infection
* white, thick, curdy d/c
* no odor
* itching
76
bacterial vaginosis
* thin, gray/white or yellow/green d/c
* malodorous
* profuse
77
gonorrhea
•green d/c
•dyspareunia; dysuria
*r/o PROM
78
chlamydia
* yellow d/c
* asymptomatic in women
* no abx tx -> PID
79
trichomoniasis
```
•thin green/yellow d/c
•malodorous
•itching, redness, edema
•looks like sperm
*both partners need abx and refrain from sex
```
80
syphilis
* painless chancre (male ID)
* primary, secondary, tertiary
* PCN ONLY tx
81
herpes
* blisters
* severe vulvular pain; dyspareunia
* no cure
82
toxic shock syndrome
* caused by staph
* leads to hypovolemia, hypotension, shock
* s/sx: flu-like, hypotension, rash
83
best indicator of endometrial cancer
•bleeding after menopause
•hypertensive
*most common malignancy of reproductive system
84
primary amenorrhea
* menarche after 16
* menarche 1 yr later than mom
* menarche same age as sister
85
secondary amenorrhea
* absence of 3 menstruation cycles after regular established
| * most common cause is PG
86
primary vs. secondary dysmenorrhea
* primary has unkind cause
* secondary d/t dz (fibroids, endometriosis, PID)
* tx: OCPs; NSAIDs
87
endometriosis
•endometrial cells grow outside of uterus
•often leads to infertility b/c of tube/ovary occlusion
•laparoscopic dx
•no tx necessary if no pain or PG desire
•surgery if s/sx severe
*hyoestrogenism bone loss r/t med tx reversible after stop med
88
basal body temp and ovulation
* decreases right before
* increases during
* stays high if PG
89
physical changes of menopause
```
•cessation of estrogen/progesterone
-dry
-hot flashes
-insomnia
•bladder, vag, urethra atrophy
```
90
diaphragm
•6 hrs before sex
•leave in 6-8 hrs
•refit q2-3yr or if 10 lb change
*r/o toxic shock
91
cervical cap
•30 min before sex
•leave in 6-8 after
*r/o toxic shock
92
spermicide
* 15-30 min before sex
| * reapply q1h or each encounter
93
female condom
•8 hrs before sex
94
PAINS
```
•IUD warning signs
Period late/abnormal
Abd pain
Infection
Not feeling well
String length change
```
95
combined oral contraceptive (COC) fxn
* suppress ovulation
* thicken cervical mucous
* effect endometrial lining
96
ACHES
```
•COC AE (call MD)
Abd pain
Chest pain; cough
HA; dizzy
Eye problems
Severe leg pain
*don't stop pill abruptly
```
97
progestin-only pill (mini pill)
* changes endometrium and cervical mucous
* best if lactating or > 40 y/o
* MUST take @ same time
98
most likely spot to have atypical cervical (cancer) cells
* transformation zone
| * where changes from cervical cells to endocervical cells
99
Peau de' orange
•abnormal breast tissue texture that indicates inflammatory breast cancer
100
when is COC contraindicated
* > 35 AND smoke, HTN, migraine
| * hx of thrombolytic complication
101
induction via oxytocin contraindicated if...
* late decelerations
| * positive CST b/c ctx put fetus in distress
102
health risks associated w/ menopause
* osteoporosis
* obesity
* heart dz
103
when are PMS s/sx present
* week before menstruation
| * resolve w/in couple day of menses onset
104
what test helps dx IUGR
•doppler blood flow
105
possible neonate condition d/t steroid admin in utero...
•hypoglycemia
106
MgSO4 classification
•CNS depressant
| *neonate r/o resp. suppression
107
normal respiration findings of preterm
•5-10 sec of respiratory pauses followed by 10-15 sec of rapid compensatory respirations
108
RN intervention shoulder dystocia
•suprapubic pressure
109
RN interventions for FHR decels and hypertonic ctx
* turn pt on side FIRST
| * discontinue oxytocin
110
first intervention if pt reports no fetal movement
•auscultate for FHR
