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