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107 Cards in this Set
- Front
- Back
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Transport hemoglobin to tissues
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Primary function of Erythrocyte
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Transport carbon dioxide away from tissues
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Secondary function of Erythrocyte
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Hemoglobin: Non-Pregnant & Pregnant
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Non-Pregnant: 12-16 g/dL
Pregnant: >11 g/dL |
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Hematocrit: Non-Pregnant & Pregnant
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Non-Pregnant: 37-47%
Pregnant: > 32% |
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Defends the body against infection
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Primary Function of Leukocytes
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Removes Debris
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Secondary Function of Leukocytes
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White Blood Cell Count: Non-Pregnant, Pregnant, Post-Partum
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Non-Pregnant: 5-10,000/mm3
Pregnant: 5-15,000/mm3 Post-Partum: 14-16,000/mm3 |
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How is a diagnosis of Puerperal Infection made?
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an increase in WBC count of > 30% in 6 hrs AND objective signs & symptoms
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REEDA
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redness, edema, ecchymosis, discharge, approximation
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Signs of Infection
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REEDA
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What does A blood type have? On RBCs & in Plasma?
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RBC's: A Surface Antigen
Plasma: Anti-B Antibodies |
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What does B blood type have?
On RBCs & in Plasma |
RBC's: B Surface Antigen
Plasma: Anti-A Antibodies |
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What does AB blood type have?
On RBC's & in Plasma |
RBC's: A Surface Antigen & B Surface Antigen
Plasma: 0 Antibodies |
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What does 0 blood type have?
On RBC's & in Plasma |
RBC's: 0 Surface Antigen
Plasma: Anti-A Antibodies, Anti-B Antibodies |
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What is the Universal Blood Donor?
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O
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What is the Universal Blood Recipient?
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AB
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What does Rh refer to?
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The presence or non-presence of the D Surface Antigen on the RBC's
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Who is RhoGam given to?
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Any Rh- woman receives a half dose @ 28 weeks and a full dose post-partum if the babies blood type is +
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What do platelets in the blood do?
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1 - essential for blood coagulation
2 - essential to control bleeding |
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Platelet Count: Non-Pregnant & Pregnant
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Non-Pregnant: 150-350,000/mm3
Pregnant: > 100,000/mm3 |
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Where does RBC production occur in adults?
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In the bone marrow
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Where are RBC's stored?
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The Spleen
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Is lowered Hemoglobin in pregnancy physiological or pathological?
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Physiological
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Why is a lowered hemoglobin level acceptable in pregnancy?
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Because there is an increase in blood volume during pregnancy which makes the ratio of hemoglobin to plasma lower.
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Why must we as care providers, know a current hemoglobin value for our patients?
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So we know if there are any oxygen level risks to the mother/baby.
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How can you build hemoglobin up?
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Iron Supplementation
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What does elevated hemoglobin indicate?
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Dehydration, Severe Edema (not w/ IV fluids)
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What does decreased hemoglobin indicate?
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Anemia, hemorrhage
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Name 2 quick signs of possible anemia
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mucosa of the mouth is pale, slow cap refill
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What does hematocrit measure?
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Ratio of RBC's to plasma volume. RBC's are needed to oxygenate tissues.
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What do hematocrit levels tell you?
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The capacity of the blood to carry oxygen to the tissues.
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Is lower hematocrit levels in the pregnant client physiological or pathological?
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Physiological. This is normal because of increased blood volume & lower hematocrit to plasma ratio.
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Why is lower hematocrit levels acceptable in pregnancy
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Because of hemodilution.
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Why do we want to know current hematocrit values on our laboring patients on admission.
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To identify risks to the mother/baby (during labor/post-partum period)
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If we want to increase cardiac output, what position would you put them in?
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Left lateral recumbent position
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What could a diagnosis be if we see a reduced hematocrit level?
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Water intoxication
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Where are leukocytes formed?
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Mostly in bone marrow but some in lymph.
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Where are leukocytes stored?
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Spleen. Waiting to be immobilized upon infection or injury.
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Why is it normal for a pregnant client to have higher WBC counts than the non-pregnant?
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The body sees the pregnancy as a foreign invader so it ramps up WBC production in case it is needed.
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How long will WBC counts rise in post-partum.
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3 days, then it will start to taper off.
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What is the common term for Puerperal?
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Post-Partum
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What value WBC's will practicing clinicians accept? Under what circumstances?
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Up to 25,000; as long as there are no S&S's
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Name possible infection sites for vaginal delivery clients.
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Cervix, Uterus, Episiotomy, Urethra, IV Site, Breasts
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What additional sites might you expect infection in C-Section clients.
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Abdominal wound, uterus incision, Lungs
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Agglutination
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When blood turns too thick to cycle because of the introduction of the wrong blood type.
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What is the result of Agglutination?
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Patient death.
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If a patient is A type blood, what blood type can they receive?
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A & O
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If a patient is B type blood, what blood type can they receive?
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B & O
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If a patient is O blood type, what blood type can they receive?
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O
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If a patient is AB blood type, what blood type can they receive?
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All
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What Rh factor would have the D antigen on the RBC's?
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+
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If there is an antigen, what is the reaction?
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Antibody formation
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What is the most common Rh factor in the US?
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+
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Why do we need to know the blood type of the laboring mom upon admission?
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1 - in case of an emergency hemorrhage
2 - for maternal fetal compatability |
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The most common way to classify blood is?
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ABORH
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What blood type can the O type patient receive?
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O
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List blood type from most common to least common
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O, A, B, AB
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What antibodies are in the plasma of an Rh- woman?
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Anti-D antibodies
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What is the purpose of a gammuglobulin?
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It interferes with an immune response.
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What is RhoGam
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a Gammuglobulin
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What does RhoGam do?
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Prevents the risk of Rh Incompatability.
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In Rh- moms that lose pregnancy prior to viability. Do we give an RhoGam shot?
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Yes. We don't know babies blood type but need to prevent any possible Rh Incompatability.
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RhoGam is considered blood products. What happens to people of religions who won't accept blood products?
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Informed Consent. They have 72 hours to decide. After 72 hrs RhoGam is no longer effective.
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What is another term for platelets?
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Thrombocytes
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Thrombocytopenia
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Reduction of blood platelets below the level of clotting.
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What is the concern of low platelets?
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Hemorrhage
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What can cause thrombocytopenia?
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Imbalance in production of bone marrow, imbalance in the spleen.
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What is the platelet value is less than 80,000/mm3?
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Anesthesia will not give them an epidural because of the reduced clotting factor.
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What if platelet levels are too high?
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Risk of thrombus, clotting, etc.
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When is the greatest risk for thrombus formation?
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First 2 weeks postpartum. Platelet counts climb during first 2 weeks.
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What does serology test for?
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Syphilis
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What test is done for syphilis?
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RPR/VDRL
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What result are we looking for to be a negative Syphilis result?
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Non-reactive or Negative
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Is RPR/VDRL (for syphilis) a screening or definitive test?
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Screening
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What is the definitive test for Syphilis?
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Western Blot or ELISA
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What is the significance of a positive Syphilis result in a neonate?
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Congenital Syphilis
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How can a neonate contract congenital syphilis?
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Through transplacental transmission that occured in-utero. Can be incompatible with life.
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What is the outcome for syphilis treatment of the mom is dependent upon?
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1 - when she contracted syphilis
2 - how long it was b4 she was treated. |
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What has the CDC reclassed Hepatitis B as?
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A STD because this is the most common mode of transmission.
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Who receives Hepatitis B testing?
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All women
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What is the desired result of Hepatitis B testing?
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Negative
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Those that have had Hepatitis B vaccinations. What would their result be?
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Positive.
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Those who have been immunized for Hep B, do we have the active disease?
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No. We know we've been immunized to prevent the disease in us. That would be part of the explanation.
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If an unimmunized woman has a positive result, then she has been exposed to the active disease. T F
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T
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What is the concern to the HC provider when dealing with a laboring Hep B positive woman?
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Prevention of transmission.
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Who else should we be concerned about with Hep B positive women?
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The neonate
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How can the neonate contract HepB from the mother?
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In-utero. It is a blood born pathogen.
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How do we protect the baby of an HBSaG+ woman?
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The baby receives a gammuglobulin within 12 h after birth. Because it stops the immune response. The gammuglobulin is called HBig.
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How do we protect the baby from Hep B in HBSaG- women?
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Baby receives Hep B vaccinations beginning at birth. Because it is an immunization it requires written consent.
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What is the desired value when testing for Rubella?
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Immune
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What values do we want to see for Immunity to Rubella?
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Typically >10 (look at lab sheet, it will tell you)
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What is the desired response that we want after a Rubella vaccination?
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Immune
Equivocal (< 10 > 3/4)? Not Immune (<3 or 4) |
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Why would we not vaccinate a pregnant woman for Rubella?
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Rubella is a known teratogen (toxic to baby).
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When do we give Rubella vaccine?
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Postpartum
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What 2 groups would we immunize?
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Equivocal & Not Immune
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What is congenital rubella syndrome?
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When a equivocal or non immune pregnant mom gets exposed to live Rubella & gets it, the baby is also exposed.
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If you have to give RhoGam to Rh - woman postpartum & you need to give Rubella vaccination because titer is too low, what do you do?
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You still give both; however, 3 months postpartum, she comes back & gets titer drawn, if still equivocal, pregnancy test & if -, then another Rubella shot.
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What is patient teaching for child-bearing age women when receiving Rubella vaccination?
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Should not achieve pregnancy for at least 90 days.
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Can breast feeding moms get Rubella vaccination?
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Yes. It is a very large molecule and will not pass through the breast.
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Does Rubella vaccine require informed consent?
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Yes. All vaccines should receive Informed Consent.
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Who do we test for Group B Beta Strep?
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All pregnant women
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Why do we test all pregnant women for Group B Beta Strep?
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Because Group B Beta Strep is associated with very adverse outcomes to neonates.
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How many doses of medication do you want to give a laboring GBS+ mom?
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At least 2 doses so she needs to delivery at least 4 hours after she comes in.
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At what gestation do we test for Group B Beta Strep?
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36 weeks.
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What is the most effective treatment that we use for laboring GBS+ moms to prevent contraction to baby on delivery?
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Penicillin - 5,000,000 unit bolus & then 2.5M units q 4 h.
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Does GBS+ moms need antibiotics after delivery?
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No.
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Who is at risk for GBS+ moms?
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Neonate
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