NUR 416-OB Exam 3 Topics PDF

**NUR 416- OB** **Topics for Exam \# 3** **[Newborn at Risk --]** 1. **Identification of the newborn at risk** - Preterm/prematurity - Post term infants - APGAR under 7 2. **IUGR** - Baby doesn't grow to normal weight during pregnancy 3. **SGA** - Infants m...

**NUR 416- OB** **Topics for Exam \# 3** **[Newborn at Risk --]** 1. **Identification of the newborn at risk** - Preterm/prematurity - Post term infants - APGAR under 7 2. **IUGR** - Baby doesn't grow to normal weight during pregnancy 3. **SGA** - Infants may be normal based on ethnicity or height and weight of parents -- could be due to environmental or pathologic genetic reasons - At risk for hypoglycemia, polycythemia, hypocalcemia 4. **LGA** - Infants are at high risk for birth injury, perinatal asphyxia, and hypoglycemia - Common in infants of mothers with obesity, diabetes, and excessive weight gain in pregnancy 5. **Impact of DM on the newborn** 6. **Hypoglycemia management** - Infants with mild hypoglycemia = early feedings - Monitor as per facility protocol - Give IV dextrose for symptomatic newborn or TPN 7. **Postterm/Postmaturity syndrome** - Post term infants are born over 42 weeks - Post term infants may be macrosomia or SGA because of aging placenta - Complications = birth injuries, oligohydramnios, low APGAR, cerebral palsy, meconium aspiration - Almost leather like, dry cracked skin, insignificant vernix caseosa 8. **Prematurity** - Risks - Infection - Fetal anomalies - Preeclampsia/eclampsia - Characteristics - Thermogenesis - feeding methods - Complications 9. **Care of the family with an at-risk newborn** 10. **Fetal Alcohol Syndrome (FAS)** - Characteristics = - Skin folds at corner of eye - Low nasal bridge, short nose - Indistinct philtrum (groove between nose and upper lip) - Small head circumference - Small eye opening - Small midface - Thin upper lip - Nursing care = - Social work - Occupational, physical, & speech therapy - Allow extra time for feeding 11. **Drug exposed infant** - S/S = - Irritability, hypertonia, jittery, seizures - Diarrhea, vomiting, feeding intolerance - Sweating, sneezing, pupillary dilation - Nursing care = - quiet environment, swaddle, small feedings, avoid eye contact (cocaine), cluster care, initiate seizure precautions - allow extra time for feedings 12. **RDS (Respiratory Distress syndrome)** - Most associated with prematurity - Causes = - Surfactant insufficiency = immature lungs - Bronchopulmonary dysplasia (BPD) = lungs are stiff and noncompliant, requires treatment complication of artificial respiratory support - Persistent pulmonary hypertension of neonate (PPHN) = left to right shunting and hypoxia, underdeveloped or abnormal pulmonary vascular, or lung disease - Transient tachypnea of newborn (TTN) = form of pulmonary edema resulting from failure to clear fluid from lungs - Meconium aspiration syndrome (MAS) = aspiration of meconium in the fetal lungs resulting in airway obstruction, inflammation and chemical irritation, infection and inactivation of surfactant - S/S = - Tachypnea - Nasal flaring - Expiratory grunting - Retractions - Cyanosis - pallor - Clinical therapy = - Assisted ventilation, surfactant - Apnea monitor - Supportive care = thermoregulation and adequate nutrition 13. **Transient Tachypnea of the newborn (TTN)** - Causes = pulmonary edema resulting from failure to clear fluid from lungs - S/S = tachypnea, nasal flaring, expiratory grunting, retractions, cyanosis 14. **Meconium Aspiration** - S/S = difficulty breathing, low HR, cyanosis, tachypnea, grunting, chest retractions, limpness - Causes = stress, infection or low levels of O2 causing them to inhale amniotic fluid into lungs that contain meconium - Management = - Adequate ventilation and perfusion - Providing antibiotics - Thermal-neutral environment - O2 support, surfactant therapy 15. **Cold stress** - Occurs with uncontrolled hypothermia when blood vessels constrict to conserve heat -- metabolic rate increases as does O2 consumption - Treatment = - Monitor for skin pallor with mottling and cyanotic trunk, tachypnea - Warm slowly over 2-4 hrs - Give O2 - Skin to skin with mother or under prewarmed heater 16. **Jaundice** - Physiological (after 24 hrs of life) - Newborns shortened RBC lifespan and breakdown of fetal RBC's - Live immaturity - Pathological (within 24 hrs of life) - Results from underlying disease - Caused by blood group incompatibility (ABO), infections, or RBC disorders - Hemolytic - Direct Coombs test = blood test to check for hemolytic disease of newborn (determines the cause) - Done on baby's cord blood to detect antibody positive RBS - Phototherapy - Used in hospital or home -- exposes infants skin to particular wavelength of light -- exposure converts the bilirubin to water soluble form being excreted in bile or urine - Bili blanket - Single or double banks - Tests - Direct Coombs test - Screen infants by transcutaneous bilirubin (TcB) measurements - Results confirmed by total serum bilirubin (TSB) measurements 17. **Rh alloimmunization** - Rh -- women who carry Rh + fetus either to term or by spontaneous or induced abortion - at delivery fetal RBC's invade maternal circulation stimulating production of Rh antibodies (first offspring not affected) - in following pregnancies Rh antibodies cross the placenta and enter fetal circulation - severe hemolysis (breakdown) of RBC in fetus - prevention = - ABO incompatibility - Administer Rhogam if mom is Rh -- - Give at 28 weeks and within 72 hours after birth 18. **Preterm Newborn** - Characteristics - Presents 2 hrs after birth with signs of respiratory distress - Tachypnea, nasal flaring, expiratory grunting, retractions, cyanosis - Breath sounds typically clear & symptoms clear in 24-48 hrs but can stay up to 72 hrs - Management - If O2 is required keep above 90% via hood or nasal cannula - Keep in thermal neutral environment - Tachypnea are unable to feed -- NG tube - Restrict fluids first 24 hrs if severe - Complications - RDS - Intraventricular hemorrhage (IVH) - Hypothermia, hypoglycemia - Jaundice - Feeding difficulties 19. **Medications given in pre-term infant** - Surfactant to help with lung development - Antibiotics to help with infection if present - Diuretics to manage excess fluid **[Chapter 26 Wellness and Health Promotion ]** 20. **Breast Cancer** - Screening/Examination - Mammogram every 1-2 years, age 40-75 - After gave 75 women should have mammograms based on SDM - Clinical breast exam every 1-3 years, age 29-39 and annually after - Risk factors - Family history - Radiation to chest from ages 10-30 - First both after age 30 - Never given birth - Dense breasts - History of benign biopsy - Use of exogenous estrogen 21. **Pap smear** - Screening - First screening at 21 - Screening every 3 years until age 30 - After 30 women should receive pap test and HPV testing every 5 years until 65 or pap test alone every 3 years - Screening may end at 65 - Pelvic exam yearly - If test is abnormal -- colonoscopy is performed for further examination of cervix 22. **IPV signs** - Bruises in different phases - Frequency of injuries (face, head, neck) - Reported history of the injury inconsistent with the presenting problem - Depression, anxiety, substance abuse 23. **STI's screenings** - Chlamydia & gonorrhea - Annually for all sexually active women under 25 - Women 25+ with new sex partners, more than one partner or a partner with a known ST - Pregnant women - Syphilis - Pregnant women at the first visit - Annually for men who have sex with men - HIV - All adolescents - Pregnant woman at first visit - Annually for men who have sex with men - Hepatitis B - All pregnant woman at their first visit - Past and current drug users - Hepatitis C - All pregnant women with current or past injection use, unregulated tattoo, or long term hemodialysis - Past and current drug users - Individuals who test positive for HIV 24. **Physical activity** - 2.5 hours of moderate aerobic activity per week or 1 hour and 15 min of vigorous exercise - Moderate exercise - Walking briskly - Water aerobic - Bicycling - Dancing - General gardening - Vigorous exercise - Swimming laps - Jogging - Aerobic dancing 25. **Nutrition assessment** - Dietary evaluation to identify where the patient might need education or other interventions can help diagnose anorexia, bulimia nervosa and binge eating - Assessment strategies - 24 hour diet recall interview - Food diary or online food tracker - Formal questionnaire - diets high in fiber may reduce heart disease, type 2 diabetes, colon cancer - vegans need supplemental vitamin B 26. **Osteoporosis** - Loss of bone mass after the age of 35 **[Chapter 27 Common Gynecologic Conditions]** 27. **Fibrocystic breast changes** - Treatment - No treatment needed once doctor verifies no cancer present - Wear good bra both day and night if pain present 28. **Endometriosis** - Symptoms = dysmenorrhea, dyspareunia, infertility, pelvic mass, pelvic pain/cramping - Treatment and Implications - NSAID's, combined oral contraceptive or MPA, Danazol, GnRH agonist (Lupron) category X - Laparoscopy for definitive diagnosis and removal of endometrial lesions (electrocautery) or Hysterectomy 29. **Polycystic ovarian syndrome (PCOS)** - Most common endocrine disorder that causes infertility in women - S/S = - abnormal uterine bleeding patterned for age or first time since menses - abnormal uterine bleeding persisting for 1-2 years - moderate to severe hirsutism - moderate to severe acne - persistent laboratory elevation of testosterone - Treatment = - metformin to improve insulin sensitivity and utilization - Spironolactone or Eflornithine to decrease symptoms such as excessive hair growth and acne 30. **Cervical cancer** - Surgical treatment = hysterectomy - Radiation = chemotherapy - pre-post operative care 31. **Gynecological cancers - ovarian, uterine, vaginal, vulvar** - Diagnoses = biopsy - Risks = multiple sexual partners - Symptoms = vaginal discharge, watery, pink brown and foul smelling, leaking urine and feces from vagina, abnormal vaginal bleeding between periods, intercourse or menopause, painful sex, loss of appetite, fatigue, pelvic pain - The prognosis depends on the type and stage - Treatment includes = - total hysterectomy (TA -- remove uterus and cervix) with bilateral salpingo-oophorectomy (both ovaries) (TAH,BSO) - surgical removal of the cancerous tissue - chemotherapy and radiation as needed - advise woman that TAH,BSO will cause premature menopause - all cancers are staged based on the TNM staging system 32. **Breast Cancer** - Treatments - Surgery (lumpectomy, radical mastectomy, modified radical mastectomy, simple mastectomy) - Chemo therapy, radiation therapy, hormone therapy - pre-post op care = assess wound for healing 33. **Menopause** - When a woman has not menstruated for a full 12 months in the absence of any other reason - Typically occurs around age 51/52 34. **Pelvic prolapse** - Pelvic organs are held in place by a combination of connective tissue and muscles of the pelvic floor, hormonal changes make those muscles weak and pelvic organs descend into the vagina - Treatment - Vaginal pessaries (silicone ring) - Pelvic organ support - Physical therapy - surgery **[Chapter 28 Infections]** 35. **Infections such as Bacterial vaginosis** - BV = associated with higher than normal pH in the vagina that allows certain bacteria to become dominant -- only females affected - S/S = fishy vaginal odor, thick white/grey discharge - Often resolves spontaneously but may be treated with clindamycin, oral metronidazole or vaginal cream - Candida vulvovaginitis -- yeast infection - Causative organism = candida albicans - Thick cottage cheese like vaginal discharge - Acute vaginal dryness, itchiness - Examination findings include inflamed tissue of the vulva - Treatment = Monistat topical, for men no treatment is necessary 36. **PID** - Causes - Chlamydia - Trichomoniasis - Neisseria gonorrhoeae - Undiagnosed STD's - Implications - More common in sexually active women younger than 25 - Multiple sex partners - IUD - Douching - Diagnosis - A physical examination of your pelvic area to check for tenderness and swelling - Blood tests - Urine tests - Swab of vagina and cervix - Ultrasound - Laparoscopy 37. **Chlamydia** - Most common diagnosed bacterial STI in the states - S/S = often asymptomatic, dysuria and frequency of urination - Men may experience urethritis - Females may experience cervicitis, PID - Treatment = azithromycin or doxycycline 38. **Gonorrhea** - Bacterial STI that may cause infertility, ectopic pregnancy, and pelvic pain - S/S = similar to chlamydia, locally enlarged lymph nodes - Screening = routine screening since most people are asymptomatic - treatment = single dose of ceftriaxone and azithromycin or doxycycline - some strains are antibiotic resistant - sexual partners should be treated - law mandates reporting 39. **Syphilis** - STI that occurs in 4 stages - Primary = may present as a single, painless chancre - Multiple uncomfortable lesions where the point of entry was - Secondary = individual may have a rash, fever, weight loss - Latent = asymptomatic period that may last for years - Tertiary = may affect multiple organ systems including brain, nerves, and joints - Blood tests = venereal disease research lab (VDRL) (RPR) - Treatment = penicillin G is the treatment of choice - Single dose - Treat both partners - Doxycycline/tetracycline if allergic to PCN - Law mandates reporting 40. **HPV** - HPV vaccination: Gardasil or Gardasil 9 for 9-26 years old before having sex, ideally at age 11, both sexes, 3 doses - Treatment = for genital warts apply creams Imiquimod, podofilox 41. **Toxic shock syndrome (TSS)** - S/S = abnormally hypotension, flu-like symptom, rashes especially on the palms and bottoms of the feet, peeling skin, seizures 42. **HSV** - Transmitted by skin-to-skin contact, usually of the mucosa - No cure HSV1 and HSV2 - Present with = - Small red bumps with blisters - Open sores in are where virus enters body - Cervix, vagina and other peritoneal area - Results in inflammation and pain - Flu-like symptoms may develop or asymptomatic - Itching, burning genital, anus area - Treatment - Acyclovir - Oral analgesics - Cool compress that has peppermint - Outbreaks are triggered by emotional stress, use of corticoid steroids, sexual intercourse - Abstain from sex while lesions resolve - Good handwashing technique **[Chapter 29 Family Planning]** 43. **Contraception: Types, pros/cons/contraindication/complications All methods of contraception's e.g., coitus interruptus** - Types = - Long-acting reversible contraception (LARC) (implants) - Combined oral contraceptives (COC's) - **Progestin only pills (POP's)** - **Hormonal patches** - **Hormonal rings** - **Barrier methods** - **Spermicide** - **Natural family planning** - **Withdrawal** - **Contraceptive injections** - **Sterilization** - **Bilateral tubal litigation (BTL)** - **Vasectomy** 44. **Combined oral contraceptives (COC's)** - Relief of menstrual symptoms, lessened cramps, decreased flow, improved cycle regularity - Side effects = weight gain, depression, break through bleeding, thromboembolism - Contraindications = migraine with aura, history of DVT, hypertension, \>35 years old, diabetic retinopathy 45. **Progestin only pills (POP's)** - **Safe for breastfeeding mothers** - **Must be taken within 3 hr window every day to be effective** - **Side effects = less regular period and more breakthrough bleeding, clots** - **Patients reporting chest pain and SOB should go to ER** 46. **Hormonal patches** - **Rotate site placement weekly to avoid skin irritation** - **Upper back** - **Upper arm** - **Upper butt** - **Lower abdomen** - **Not on breasts** - **Applied weekly for 3 weeks** 47. **Hormonal rings** - **Ring can be dislodged during bowel movement -- learn to check placement of the ring** - **Ring can be removed for intercourse and left out for up to 3 hours a day** 48. **Natural family planning** - **calendar** - **track menstrual cycle to determine time of ovulation** - **avoid intercourse for 8-19 days** - **basal body temperature (BBT)** - **symptom base method, a slight dip temperature just before ovulation, then rises sharply and thinning** - **billing or cervical mucus method** - **time of ovulation mucous is clear and stretchy** 49. **Withdrawal** - **Coitus interruptus** - **Be aware ejaculatory fluid can leak from the penis prior to ejaculation -- contains sperm** - **Free, safe and acceptable where religious beliefs prohibit other methods** - **Highest risk for unintended pregnancy** 50. **Contraceptive injections** - **Depo Provera** - **Progestin only injection** - **Given every 13 weeks until pregnancy is desired** - **Side effects = weight gain, decreased bone mineral density** - **Maintain adequate intake of calcium and weight bearing exercises** - **Benefits = less frequent or scant menses** - **Don't massage the site = decreased absorption** 51. **Implants / intrauterine contraception (IUD)** - **IUC's or IUDs are T shaped plastic devices inserted into uterus** - **Releases chemical substance that damage sperm** - **Copper IUD -- 10 years** - **Paragard** - **Doesn't contain hormones** - **Progestin IUDs -- 5 years** - **Skyla, Lileets, Mirena** - **sign consent form** - **preform pregnancy test** - **can reverse immediately** - **can cause irregular menstrual bleeding** - **requires the collection of cultures for STI prior to placement** - **women should report -- acute cramping, bleeding, late period, fever, unusual bleeding, pain with sex** - **contraindicated in women with menorrhagia (periods 7+ days** - **risks for -- BV, PID, uterine perforation, uterine expulsion** - **implant -- 4 cm rod inserted under skin of upper arm** - **Implanon and Nexplanon** - **Effective for 3 years** - **Suppresses follicle maturation/ovulation** - **BMI \> 30 may reduce effectiveness** - **Unscheduled bleeding is common side effect** - **Majority of women ovulation within one month of removal** 52. **Vasectomy** - **Local anesthesia** - **Safest means of permanent sterilization and most cost effective** - **Involves clamping, cutting and sealing the vas deferens to release sperm** - **Takes about 6-8 weeks to be effective** - **Resume sex 1 week after** - **Use birth control until negative sperm test** - **Doesn't protect against STI's** 53. **Barrier Contraceptives** - Male condoms - Less effective as contraceptive but best protection against STI's - Apply prior to genital contact on erect penis, leaving space at the tip for sperm reservoir - Remove and discard immediately after ejaculation - Diaphragm - Flexible saucer placed into vagina to cover cervix and area around it - Doesn't protect against STI's - Fit should be checked if woman gives birth, has a miscarriage or abortion, or gains or loses more than 10 pounds - Replace every 2 years - Contraceptive sponge - Spermicide infused foam disk that fits over the cervix - Wet and insert with fingers - May be placed up to 24 hrs before sex -- no more than 30 hrs - Risk for TSS if left in vagina 54. **Emergency contraception** - Side effects = nausea, vomiting, headache, irregular bleeding - Levonorgestrel (plan B) - Take within 72 hours - Won't work when ovulating - Works by preventing ovulation and doesn't affect a pregnancy - Ulipristal (Ella) - Prescription only - Use within 120 hours of unprotected intercourse - Works as a progestin blocker and may affect an existing pregnancy 55. **Infertility** - **Lack of conception despite unprotected sex for at least 1 year (6 months if the woman is over 35)** - **Causes =** - **May be related to male factors or female factors** - **Prolonged heat exposure = gonadotoxin** - **Pharmacological agents** - **Clomiphene citrate (clomid) = common first line medication to induce ovulation** - **Side effects = breast pain, tenderness, nausea, vomiting, flushing** 56. **Evaluation of female ovulatory factors** - Menstrual history - Urine testing for luteinizing hormone and/or progesterone level - Hysterosalpingogram to assess urine cavity and patency of fallopian tube - Serum follicle stimulating hormone and estradiol levels on the third day of menses - Thyroid stimulating hormone levels 57. Salpingogram - Test used to determine infertility - Don't perform if patient is allergic to shell fish 58. **Semen Analysis** - semen collection 59. **Physiologic and psychological concerns/effects** - Ovarian hyperstimulation syndrome (OHSS) may occur - Ovarian enlargement, severe GI symptoms, abdominal swelling/pain, SOB, pleural effusions, decreased urination