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113 Cards in this Set

  • Front
  • Back
What are some paternal (father) factors that contribute to high-risk pregnancy?
*Chronic alcohol abuse
*Drug abuse
*Exposure to chemicals
What factors place a woman at high risk for HIV infection?
*woman/partner from geographic areas where HIV is prevalent
*woman/partner who uses IV drugs
*multiple partners/history of bisexualism
*persistant/recurrent STD's
*blood transfusions between 1978-1985
*exposure to contaminated blood/body fluids
On average, what is the asymptomatic period once a person is infected with HIV?
10 years
In regards to prenatal care, what is true of HIV screening?
HIV screening should be part of all prenatal care
What are some assessment findings that might indicate HIV in a pregnant woman?
*Weight loss
What are major signs of worsening HIV?
*Weight loss > 10% of the pre-pregnancy body weight
*Chronic diarrhea for longer than 1 month
*Fever (intermittent or constant) for longer than 1 month
What are the defining symptoms of AIDS in women?
*Wasting syndrome
*Esophageal candidiasis
*Herpes simplex virus
*Kaposi's sarcoma (rare)
*Vaginal candida
What is wasting syndrome?
Severe weight loss (wasting away)
What should be the main focus of care for a pregnant woman with HIV/AIDS?
Counsel about implication of the diagnosis
List some major ANTEPARTUM nursing interventions for a pregnant woman with HIV/AIDS:
*Assess for wieght loss/fever
*Assess for respiratory problems
*Visual exam
*No amniocentesis
*Vaccinations as recommended
*Triple drug therapy (i.e., zidovudine/didanosine/ indinavir
*Serial ultrasounds for IUGR
*Weekly non-stress test after 32 weeks
*Provide counseling
What is the primary focus during labor/delivery when a woman has HIV/AIDS?
Protection of the newborn from transmission during the birth process
What can help to prevent the transmission of HIV/AIDS to a newborn during labor/delivery?
*Less vaginal examinations
*No internal fetal monitoring
*No vacuum
*Scheduled c-section @ 38 weeks gestation, to decrease risk of SROM
What is important regarding breastfeeding when a woman has HIV/AIDS?
Breastfeeding is contraindicated (should be discouraged strongly)
What should alert a caregiver of HIV infection in a newborn?
Opportunistic infection (lymphoid interstitial pneumonitis (LIP), oral candidiasis, etc.)
List some signs of AIDS in infants:
*Failure to thrive
*Epstein Barr virus
*Swollen glands
*Recurrent infections
*Diarrhea/weight loss
*Neuro/cog/dev. deficits
What are some cranial/facial stigmas associated with AIDS contracted early in utero?
*Patulous lips
*Mildly oblique eyes
*Prominent, box-like forehead
*Increased distance of inner canthus of eyes
*Flattened nasal bridge
What are some care measures of a newborn born to an HIV+ woman?
*Standard precautions
*No circumcision
*Care of umbilical cord (clean)
*Prophylactic gamma globulin
*Give ZDV
*Give vaccinations EXCEPT live virus vaccines
*Prophylactic PCP vaccine
*Routine monitoring
What must be done when a newborn is positive for rubella?
Must be isolated - very infectious
Which group does cytomegalo virus belong?
Herpes simplex virus group
Where is cytomegalovirus found?
*Cervical mucus
*Breast milk
What is true regarding transplacental infection of Herpes?
Very rare
How does transmission of herpes usually occur from mother to baby?
*After ROM
*Virus ascends during birth through an infected birth canal
What are the most common causes of infant death related to group B strep infections?
*Respiratory distress
When should a pregnant woman be screened for GBS?
between 35-37 weeks gestation (both vag and rectal)
What is important to know regarding Hep B transmission?
Can be transmitted perinatally
What is important to know regarding newborn care when the mother is positive for Hep B?
*Give Hep B vaccine within 12 hours of birth
*Bathe before any injections or heel sticks
*Give HB immune globulin
What is the drug of choice for treatment of Group B Strep?
What other drugs (besides penicillin) are used to treat Group B Strep?
When should antibiotics be administered to a pregnant woman who is positive for Group B Strep?
At onset of labor or with ROM
What increases the risks associated with Group B strep in pregnancy?
*Premature birth
*Maternal intrapartum fever
*Membranes ruptured greater than 12-18 hours
*Previously infected infant with GBS
*GBS bacteriuria in current pregnancy
Define infertility:
Lack of conception despite unprotected sexual intercourse for at least 12 months
Although prevalence of infertility is 10-15%, what percentage can achieve pregnancy with treatment?
Approximately 65% of those in the infertile category
What is true regarding cervical mucus to ensure fertility?
It must be favorable to ensure survival of spermatozoa and facilitate passage to the upper genital tract
What must be true regarding the fallopian tubes in order for a woman to be fertile?
Fallopian tubes must be patent and have:
1)normal fimbria, with
2)peristalic movements toward the uterus
Normal fimbria with peristalic movements toward the uterus facilitate what?
Transport and interaction of ovum and sperm
What must the ovaries do in order to be considered fertile?
Produce and release ova in a regular cyclic fashion
What type of hormones must be present in adequate amounts in order for fertilization to occur?
Reproductive hormones
To be fertile, the endometrium must be in a physiologic state that allows what to take place?
Implantation of the blastocyst
List some common causes of female infertility:
*Ovulation disorders
*Cervical factors (mucus, etc.)
*Tubal factors
*Endometrial development factors
*Pelvic factors
What drug was commonly given in the 1960's to prevent abortion, and is now known to have caused malformations of the uterus, pelvis (etc.) in BABY?
DES (Diethyl sildesterol)
If a woman is charting her basal body temperature to track ovulation, when should you tell her to take her temperature each day?
First thing in the morning, before she gets out of bed
What hormones are assessed in a diagnostic infertility work-up?
What does a transvaginal ultrasound monitor?
Follicles and ovulation
What cervical mucus assessments are used to determine whether it is favorable to sperm?
What is inspected during a pelvic laparoscopy and hysterography?
*Shape of uterus
*Color of tissue
*Mobility of uterus/tubes/ovaries
What must be produced by the testes in order to be fertile?
spermatozoa of normal quality, quantity and motility
What classifies male genital tract secretions as "infertile"
*Less than 20 million sperm/ml
*Less than 50% motility
How must ejaculated spermatozoa be deposited in the female genital tract in order for fertilization to occur?
In such a manner that they reach the cervix
List some common causes of male infertility:
*Pituitary/hypothalamic dysfunction
*Hormonal problems in the testes (decreased quality/motility)
*Congenital anomalies (ex: hypospadia)
*Varicocele (scrotal/testical varicose veins)
*Substance abuse
*Antisperm antibodies
*Low-grade prostate infection
List some treatment options for male infertility:
*Medication (chemo, anti-HTN, anticholinergics, anabolic steroids)
*Lifestyle changes (substance abuse issues, etc.)
*Surgery for varicosities or cystocele
*Artificial insemination
*Therapeutic donor insemination
If a man wishes to donate sperm to a sperm bank, what advice can a nurse offer?
*Go to genetic counseling first
*Donate to a qualified sperm bank
List some situations where in vitro fertilization might be an option for infertility:
*Blocked/absent fallopian tubes
*Mucus abnormalities
*Male infertility
What is done in the in vitro process in order to obtain a number of oocytes?
Hyper-stimulate the ovaries with medications such as Perganol
Upon what does success of in vitro fertilization depend?
*Age of the woman
*Cause of infertility condition
*Skill of the professional who is performing the procedure
With in vitro, where does fertilization occur?
Outside the woman's body
With GIFT, ZIFT and TET, where does fertilization occur?
Inside the woman's body
Of GIFT, ZIFT and TET, which is the most successful?
What is the purpose of "micromanipulation" of eggs/sperm?
To determine gender, genetic health, etc.
What 6 factors are included in the infertility evaluation process?
1. Ovulation
2. Sperm count
3. Sperm-cervical mucus interaction
4. Fallopian tube anatomy
5. Endometrial development
6. Pelvic disorders
Which test is used to determine sperm-cervical mucus interaction?
Huhner test
If a couple is over the age of 35, when are they considered to be infertile?
If unable to conceive after 6-9 months of unprotected intercourse
What are fraternal twins?
Dizygotic (2 eggs & 2 sperm)
What are identical twins?
Monozygotic: 1 amnion & 1 chorion
Are Siamese twins monozygotic or dizygotic?
True or false: the rate of autism is higher in multiple gestation pregnancies
Twins are most often delivered via C-section. When might they be delivered vaginally?
Only if both are vertex presentation at the time of delivery
When twins are delivered pre-term, why is c-section important?
If the babies are very small/immature, vaginal delivery is too stressful
What causes an increased risk for postpartum hemorrhage with multiple gestation pregnancies?
Overstretched uterus can slow the labor process and lead to postpartum hemorrhage
What is the main cuase of severe birth defects?
What are the most common risks to the fetus when substance abuse is involved?
*Alterations in birth weight
*Intrauterine asphyxia
What causes intrauterine asphyxia with regards to substance abuse in pregnancy
Narcotic withdrawal/hyperactivity and subsequent high O2 consumption
What are the maternal effects of chronic alcohol use?
*Malnutrition (folic acid/thiamine deficiency)
*Bone marrow depression (increased risk of infection)
*Liver disease
*Withdrawal seizures/delirium tremens (12-48 hrs. after not drinking)
What are some interventions for the maternal effects of chronic alcohol use?
*Watch for manifestations of alcohol abuse
*Sedate pt. to decrease irritability and tremors
*Seizure precautions
*Re-hydration (IV therapy)
*Prepare for addicted newborn/fetal depression
What are the facial characteristics of babies with Fetal Alcohol Syndrome?
*Small head
*Low nasal bridge
*Small eyes
*Flat mid-face
*Short nose
*Thin upper lip
*Small jaw
What are some other physical characteristics of FAS (besides the facial characteristics)?
*Permanent brain damage
*Growth problems: shorter size/underweight
*Deformed fingers/toes
*Heart/eye/skeletal and kidney defects
*Long-term behavioral problems
What are some nursing care measures for a child with FAS?
*Avoid heat loss
*Provide adequate nutrition
*Reduce environmental stimuli
*Staff consistency (babies need to be held throughout withdrawals)
*Monitor for seizure activity/respiratory distress
*Encourage bonding
*Breast feeding will likely be contraindicated
True or false: FAS is a major cause of mental retardation
True or false: FAS can be reversed
True or false: FAS is a treatable and curable condition
Why is low birth weight likely if a pregnant woman smokes cigarettes?
Smoking causes vasoconstriction, which causes an inadequate placenta
What is true of breastfeeding if mom smokes cigarettes?
Breastfeeding is contraindicated
What condition is increased tenfold when mom smokes marijuana?
What are some common assessment findings of infants who are exposed to marijuana in utero?
*Fine motor tremors
*Prolonged startles
*Poor habituation to visual stimuli
*Hyperactive neurological state
What are some common complications of the drug-dependent newborn?
*Respiratory distress
*Congenital anomalies/growth retardation
*Behavioral abnormalities
*Withdrawal manifestations
List some very severe effects of cocaine use in pregnancy:
*Pulmonary edema
*Respiratory failure
*Cardiac problems
What are some effects of cocaine in the fetus?
*Increased risk of IUGR
*Small head circumference
*Cerebral infarctions
*Shorter body length
*Altered brain development
*Malformations of the genitourinary tract
What are some effects of cocaine in the NEWBORN?
*Neurobehavioral disturbances
*Marked irritability
*Exaggerated startle reflex
*Labile emotions
*Increased risk of SIDS
*Poor interactive behaviors
What assessment scale is used to measure interactive behaviors of a cocaine infant?
Brazelton Neonatal Assessment Scale
What are some effects in an infant when mom takes cocaine?
*Extreme irritability
*Dilated pupils
What are the stages of newborn withdrawal from heroin?
What are some nursing interventions for the heroin newborn?
*Meet nutritional needs
*Promote bonding
*Observe for respiratory distress
*Observe for jaundice
*Monitor for signs/symptoms of withdrawal
What drugs are used to control newborn withdrawal from heroin?
*Oral morphine sulfate solution
*Donnatal elixir
*Simethicone drops (Mylicon)
When is pregnancy not recommended for a woman with a history of heart disease?
If her condition is associated with cyanosis
What is the most common result of rheumatic heart disease?
Mitral valve stenosis
What is cardiomyopathy of the left ventricle?
Dysfunction of the myocardium of the left ventricle
When is cardiomyopathy of the left ventricle most likely to occur in regards to pregnancy?
The last month of pregnancy, or in the first 5 months post-partum
What are the complications of cardiomyopathy of the left ventricle?
CHF with infection and anemia
What is the drug of choice to reduce the risk of thrombus in pregnancy?
Heparin (does not cross the placenta)
What are the risks of Rheumatic Heart Disease?
*Damage of mitral valve (stenosis)
*Damage of aortic valves
*Pulmonary edema
What has caused a significant decline in the instance of rheumatic heart disease?
Treatment of group B hemolytic strep throat infections
What complications can be expected to arise in a pregnant woman with heart disease?
*Atrial fibrillation
*Repeated endocarditis
What IV solution is most like normal blood plasma?
Lactated Ringer's
What is Class I heart disease?
No symptoms with ordinary activity
What is Class II heart disease?
Ok at rest, but ordinary activity causes symptoms (dyspnea, fatigue, palpitation, anginal pain)
What is Class III heart disease?
Marked limitation of activity - less than normal activity causes symptoms
What is Class IV heart disease?
Symptomatic, even at rest. Inability to carry on daily activity.
Which heart disease classifications may have normal pregnancy / childbirth?
Classes I & II
What heart disease classifications will have complications in pregnancy?
Classes III & IV
What are some interventions for heart disease in pregnancy?
*Treat anema (anemia increases the workload of the heart)
*Treat infections thoroughly (even minor ones can increase the workload of the heart)
*Limit activity
*Limit weight gain
*Limit sodium intake to 2-4 g/day
*Assess carefully at 28-32 weeks (when max blood volume is reached)
*Teach pt. to notify doctor if she develops a frequent cough (possible CHF)
What are some signs that the heart can no longer meet the demands of pregnancy?
*Heart murmurs
What is included in drug therapy for cardiac disease during pregnancy?
*Vitamin supplements
*Anticoagulant heparin
*Thiazide diuretics
*Digitalis glycosides
What are some interventions during labor and delivery for a woman with cardiac disease?
*Reduce exertion/fatigue
*Avoid heart rate greater than 100 bpm
*Avoid respirations greater than 24/min.
*Assess lungs frequently
*Position semi-Fowlers/side-lying/HOB up
*Give oxygen
*Open-glottis pushing with complete relaxation between pushes
*Low forceps delivery
*Lumbar epidural
What should be included in postpartum care of a patient with heart disease?
*Frequent assessment for CHF/cardiac decompensation in 1st 48 hrs.
*Frequent vital sign assessment
*Semi-Fowler's or side-lying position
*HOB & shoulders elevated
*Gradual activity progression
*Stool softeners (no straining)
*Breastfeeding depends on prescribed cardiac meds