Ob Focal Points for Final Exam SP24-1 PDF

OB Focal Points for Final TO DO ​ read over booklets ​ read over textbook (chap 34, 35, 36) **Mag sulfate contraindicated with MG ​ Screening and prevention of violence against women should be screened? How and when should screening take place? (Chapter 5) o​ screeni...

OB Focal Points for Final TO DO ​ read over booklets ​ read over textbook (chap 34, 35, 36) **Mag sulfate contraindicated with MG ​ Screening and prevention of violence against women should be screened? How and when should screening take place? (Chapter 5) o​ screening for violence should be done in the initial assessment/interview o​ all women should be screened ▪​ bruising stages of healing o​ screen those for frequent somatic symptoms o​ Mandatory reporting of domestic violence ▪​ Bruises - point out the facts o​ ABCDES ▪​ alone ▪​ beliefs ▪​ confidentiality ▪​ documentation ▪​ education ▪​ safety o​ risk is when they’re trying to leave, develop a safety plan ​ Endometriosis-definition, symptoms, management (Chapter 6) o​ endometriosis: growth of tissue outside the uterus, may be implanted o​ s/s: dysmenorrhea, deep pelvic dyspareunia (painful intercourse), abnormal bleeding, excessive, decreased fertility o​ tx: surgery, o​ management: medications that are used to suppress endogenous estrogen levels ▪​ hormone, NSAIDs ​ STIs-presentation, complications associated with delivery/breastfeeding and effect on the fetus/newborn (Chapter 7/Chapter 35) STI/other Clinical Screening Treatment Nursing infections Manifestations /testing Implications Chlamydia often silent, culture PO: Conjunctivitis or symptoms not azithromycin, pneumonia in the *clams are specific doxycycline, newborn if left silent amoxicillin untreated PROM, PTL, PP endometriosis Gonorrhea women are often culture IM: ceftriaxone salpingitis in 1st asymptomatic trimester with ⅓ undiagnosed miscarriage, PPROM, preterm s/s: purulent birth, cervical chorioamnionitis, discharge, neonatal sepsis, menstrual IUGR, maternal irregularities, or postpartum sepsis, presence of pp endometriosis, acute or chronic amniotic infection pelvic pain syndrome ophthalmia neonatorum - if left untreated, can lead to blindness (baby: erythromycin) Syphilis primary: primary RPR or IM: penicillin G if left untreated lesion, chancre VDRL maternal disease appears 5-90 results in fetal or days after perinatal death in infection, 40% of case painless delayed treatment secondary: 6 can result in fetal weeks to 6 effects that range months from minor (widespread anomalies to maculopapular miscarriage/preter rash on the m birth or fetal palms and soles death and generalized lymphadenopath y) HPV - human lesions seen in history, no therapy has lesions can papillomavirus the posterior part evaluation been shown to become so large in (single or of the introitus, of s/s eradicate pregnancy that cluster) buttock, vulva, they affect vagina, anus, pap test urination, cervix defecation, physical mobility, and fetal  soft, papillary exam descent, can swellings obstruct the birth occurring singly canal, or in clusters on necessitating a the genital and cesarean birth anorectal regions bleeding after birth profuse vaginal trauma from discharge, lesions itching, dyspareunia, do not need post c-section!! Genital Herpes painful, culture chronic and congenital Simplex Virus recurrent genital recurring with infection may (HSV) ulcers no cure occur and is severe and devastating -ulcers HSV-1: more commonly HSV can also be oral-typical transmitted during “cold sore” labour and birth HSV-2: genital with lesions, need lesions a C-section Hepatitis A, B, A: flulike all three A: vaccine A: pregnant C symptoms are blood B: vaccine, no tx women exposed B: HBSAg - C: interferon alfa can receive often or with ribavirin immune globulin silent/flulike or immune C: often specific globulin asymptomatic B: may be given to NBs. NBs must receive a hep B vaccine and HBIG C: transmission through breastfeeding has not been reported HIV influenza like Blood no cure can be passed to response fetus through maternal circulation, during  labour ansd birth through ingestion of fluid or through breastmilk. ART and c section are recommended to prevent vertical transmission no breastfeeding & emergency c section!! Trichomonas may be wet prep metronidazole or could result in asymptomatic tinidazole orally preterm or low in a single dose birthweight present with yellowish, green could be frothy, transmitted to mucopurulent, newborn during copious, delivery malodorous discharge, inflammation may be present dyspareunia and dysuria Group B asymptomatic rectovagin IV Penicillin leading cause of Streptococcus al culture G/Ampicillin neonatal morbidity (not an STI) and mortality during delivery TORCH toxoplasmosis, organisms capable infections Other, rubella, of crossing the cytomegalovirus, placenta HSV influenza like symptoms in the mom more serious effects on the fetus/neonate ​ Teratogens-definition and effect on fetal development (Chapter 12) o​ substances that may produce physical or functional detects in the human embryo or fetus after the pregnant woman is exposed to the substance ▪​ examples: alcohol and cocaine, o​ developing areas with rapid cell division are the most vulnerable to malformation caused by environmental teratogens o​ 3-8 weeks of gestation is when they are most vulnerable ​ Physiologic adaptations of pregnancy-normal versus abnormal findings/red flags (Chapter 13) o​ red flags: abnormal vaginal bleeding, decreased/no fetal mvmt, early contraction, AST/ALT, bilateral suprapubic o​ normal findings: state of respiratory alkalosis (slight change of RR - change in breathing, shift to diaphragm, displacement), hypercoagulable state, physiological anemia (hemodilution; iron supplementation), decreased BP (vasodilation) in the second trimester, the fetus is engaged, round ligament pain o​ abnormal: ballottable, excessive bleeding/clotting, abnormal vaginal bleeding without physical examination, persistent headache, epigastric pain, contraction before 37 weeks, decreased fetal movement after 37 weeks, diplopia (double vision), severe headaches, SOB ​ Positive, probable, and presumptive signs of pregnancy (Chapter 13) o​ positive: the fetus ▪​ fetal heart tones (funic souffle), visualizing the fetus, palpating the fetus o​ probable: felt by an examiner ▪​ hegar’s sign, ballottement, pregnancy test, o​ presumptive: felt by the mother ▪​ amenorrhea, fatigue, breast changes, ​ Naegele’s rule and calculating estimated date of birth (Chapter 14) o​ Naegele’s rule: LMP (last menstrual period; when it started) - 3 months + 7 days = EDD ​ Normal immunizations of pregnancy-which can be safely administered (Chapter 14) o​ live viruses (not safe): MMR, varicella, some influenza o​ safe to administer: combined Tdap (pertussis), recombinant hepatitis B, COVID-19, inactivated influenza, RSV ​ GTPAL-calculations o​ G = gravida: the number of pregnancies, including this one o​ T = term: the number of pregnancies that ended in term births (37 weeks) o​ P = preterm: the number of pregnancies that ended in preterm birth (between 20 weeks 0 days and 36 weeks 6 days gestation) o​ A = abortion: the number of pregnancies that ended in miscarriage (spontaneous abortion) or elective termination (therapeutic abortion) before 20 weeks or weighed less than 500g at birth o​ L = living: the number of children currently living ​ Nutrient needs specific to pregnancy (Chapter 15)  o​ daily intake of folic acid is required (0.4mg); helps to form the neural tube (early brain and spine) ▪​ chicken, turkey, goose, lamb, beef, legumes, peas, beans, lentils, asparagus, spinach, papaya, wheat germ o​ iron o​ magnesium o​ sodium o​ zinc o​ avoid: ▪​ alcohol, caffeine (200g or greater), ​ Stages of labour - what does each stage consist of? o​ signs preceding labour: lightening (baby drops into position) and bloody show (pinkish discharge) o​ Stage 1 - the entirety of labour (0-10 cm dilation) ▪​ latency (slow) ▪​ active o​ Stage 2 - baby coming out ▪​ latency; contractions but not pushing ▪​ active; at 10cm dilated and actively pushing o​ Stage 3 - placental exit (within 20-30 mins) ▪​ shortest stage of labour, expected to exit within 20-30 minutes o​ Stage 4 - recovery ▪​ 2 hours or longer, monitor mom closely ▪​ vital signs, bleeding, fundus (every 15 minutes) ​ Interpretation of fetal heart rate tracings (VEAL CHOP) including the category of tracing (Chapter 18) Accelerations Early Decelerations Late Decelerations Variable Deceleration causes: spontaneous causes: head causes: disruption of causes: umbilical fetal movement, compression resulting oxygen transfer from cord compression – vaginal exam, from–UC, vaginal environment to fetus, maternal position, electrode application, examinations, fundal resulting in transient cord around fetus, fetal scalp pressure, placement fetal hypoxemia — short cord, knot in stimulation, fundal of internal mode of uterine tachysystole, cord, prolapsed cord pressure, etc. monitoring maternal supine hypotension, significance: usually significance: normal epidural/spinal transient and pattern. indicates fetal anesthesia, placenta correctable well-being. previa, placental interventions: turning abruption, HTN, patient on left side or interventions: none post-term gestation, if no significance: normal IUGR, DM, contraindications, pattern (no chorioamnionitis amnioinfusion can associations with begin fetal hypoxemia, significance:  Accelerations Early Decelerations Late Decelerations Variable Deceleration acidemia or low associated with _________________ APGAR scores) hypoxia, academia, _________________ low APGAR scores interventions: none for LATE DECELS: interventions: LIONs L left side I IV fluid bolus key words: key words: offset slightly, come after O oxygen (10L) the peak of the contraction N notify HCP key words: mirror S stop oxytocin image of the contractions (match) o​ category 1: Normal(early decelerations, accelerations) ▪​ moderate variability ▪​ accelerations ▪​ early decelerations ▪​ HR: 110-160 o​ category 2: indeterminate(late deceleration) ▪​ brady or tachy ▪​ minimal or marked ▪​ absent variability with normal HR o​ category 3: abnormal — initiate LIONs intervention(absent or sinusoidal) ▪​ absent variability with bradycardia ▪​ prolonged deceleration ▪​ ex. sinusoidal (occurring for more than 20 minutes) ​ Normal versus abnormal newborn findings caput succedaneum versus cephalohematoma versus subgaleal hemorrhage (Chapter 23) o​ caput succedaneum (higher risk for jaundice): edema on scalp from pressure during delivery NONDEFINED ▪​ edema, swelling; crosses the suture line ▪​ fluid o​ cephalohematoma (higher risk for jaundice): accumulation of blood under the scalp DEFINED ▪​ localized; collection of fluids – could be caused by vacuum extraction o​ more severe form: subgaleal hemorrhage ▪​ monitor VS & head circumference o​ Nursing interventions: Vitamin K shot! o​ normal: ▪​ acrocyanosis, physiologic jaundice, crying after birth, APGAR 7 and above  o​ abnormal: ▪​ respiratory distress, pathologic jaundice, central cyanosis ​ Thermoregulation-different types of heat loss in the newborn (Chapter 23) o​ thermoregulation: the maintenance of balance between heat loss and heat production **big concern for newborns o​ heat loss: ▪​ convection - body surface → cooler ambient air (set at 75.2 F) ▪​ radiation (indirect) - loss of heat from the body surface → cooler surface that’s not in direct contact ▪​ evaporation - bath (dry babies quickly afterwards) ▪​ conduction (direct) - stethoscope ▪​ complications: break down of brown fat, hypoglycemia, metabolic activity, hypothermia ​ Normal newborn reflexes-which one should be there and their names (Chapter 23) o​ babinski reflex: dorsiflexion of big toe, fanning of toes o​ moro/startle reflex: normal reflex for an infant when he or she is startled or feels like they’re falling. (startled look and the arms will fling out sideways with the palms up and the thumbs flexed) ▪​ absence of this reflex may indicate an injury or disease o​ palmar reflex: elicited by placing an object or the examiner’s finger in the palm of the infant’s hand; this leads to an involuntary flexion response o​ Sucking reflex - put finger on roof of mouth o​ Rooting - find finger to suck o​ swallowing reflex ​ Jaundice-physiologic versus pathologic o​ physiologic: normal response to additional RBCs they have to break down (after 24 hours) Goes away within 2 weeks o​ Intervention: Phototherapy (light)2 o​ pathologic (non-physiologic): abnormal jaundice (during 24 hours) ▪​ concern for kernicterus: ​ acute bilirubin encephalopathy (irreversible brain damage as a result of hyperbilirubinemia) bilirubin levels around 20 ​ s/s: lethargy, poor appetite ​ see elevation in about 12 hours (peaks 3-4 days) o​ coombs pos (+): start more lights o​ coombs neg (-): ▪​ educate: ​ ensure they eat and excrete adequately (strict I/Os) ​ watch out for lethargy ​ ensure the fetus is having an output, monitor for jaundice (eyes and skin) ​ concern: decreased output, increased lethargy, not latching ▪​ treatment ​ adequate nutrition (breastfeeding, formula) ​ phototherapy o​ reduces bilirubin levels, light therapy blanket ​ Apgar scoring-determination of the score (Chapter 24) o​ APGAR score determined at 1 minute of life and 5 minutes of life (10 mins if 5 mins is less than 7) Sign 0 1 2 heart rate absent slow (