OB exam 3 chapter 20

s/s anemia

fatigue weakness malaise anorexia susceptibility to infection pale mucous tachycardia pallor

The nurse is caring for a 2-day-old newborn whose mother was diagnosed with cytomegalovirus during the first trimester. On which health care provider prescription should the nurse place the priority?

hearing test

Cytomegalovirus (CMV)

herpes-type virus that usually causes disease when the immune system is compromised acquired from sexual contact, blood transfusion, kissing, contact with children in daycare in daycares ,mother to child in utero many babies asymptomatic s/s premaure birth, hepatomegaly, thrombocytopenia, microcephaly, hearing loss, vision loss, jaundice, lack of coordination, weakness or problems using muscles handwash frequently soap and water, diaper changes, feeding ,handling toys, wiping nose or drool. no sharing stuff. safe sex. cl

abnormal lab values anemia

hgb <11 hct <35% low serum iron <3o mcg microcytic hypochromic cells low serum ferritin <100mg

c-section inidcation

nonreassuring fetal status vascular changes

toxoplasmosis

parasitic infection hand to mouth from touching cat feces can results in : LBW, enlarged liver and spleen, choriorretinitis, jaundice, IUGR, hydrocephaly, microcephaly, neurologic damage and anemia treatment: sulfonamides during pregnancy reduce risk of infection

medicine

phenobarbital, chlorpromazine, diazepam, paregoric, methadone

iron deficiency anemia contributing factors

poor nutrition, hemolysis, pica, multiple gestation, limited interval between pregnancies, blood loss

maternal complications

preeclampsia c-section

Class IV

symptomatic at rest w/o activty

Class II

symptomatic with increased activity (dyspnea, chest pain)

class III

symptomatic with normal activity (fatigue, palpatation)

alcohol spectrum disorder look

thin upper lip, small head circumference, small eyes, receding jaw, and short nose. Other features include a low nasal bridge, short palpebral fissures, flat midface, epicanthal folds, and minor ear abnormalities.

• Group B beta-hemolytic streptococcus

• •Group B beta-hemolytic streptococcus: (direct or indirect to fetus during labor & delivery) Can cause neonatal sepsis, meningitis, and pneumonia. Colonization can also cause chorioamnionitis, endometritis, urinary tract infection (UTI) and postpartum wound infection. Screened between 35-37 weeks. Penicillin G IV is the treatment of choice, given at least 4 hours prior to delivery

opiates

Maternal and fetal withdrawal, abruptio placentae, preterm labor, premature rupture of membranes, perinatal asphyxia, newborn sepsis and death, intellectual impairment, malnutrition

hbA1c

-average over 100-120 days <7% good control >8% indicates non-control

Class I

asymptomatic, no limitation of physical activity

nursing management

-maintain placental perfusion -risk reduction measures -energy conservation (prioritize household chores, rest in side lying position) -nutrition -. increase fiver and NA -Fetal monitoring

neonatal complications of diabetes

macrosomia hypoglycemia congenital anomalies birth trauma

asthma

-severity related to asthma severity before pregnancy -poorly controlled asthma increases risk fo preclampsia, restricted fetal growth, premature birth,still birth

maternal surveillance

-urine check for protein -urine leukocytes (UTI) -urine ketones -kidney function checked each trimester -eye exam 1st trimester -hbAC 4-6 weeks -antepartal visites q2weeks up to 28 weeks, twice weeekly until birth

diet and insulin

-3 meals 3 snacks daily -40% complex carb, 35% protein, fiber -limit fat 25% and sugar -oral diabetic or insuline requires when diet alone is ineffective -insulin REDUCED first trimester but increased last 20 weeks -frequent blood glucose testing -\

fetal surveillance

-AFP to detect, NTD, ventral wall defects -serial u.s -BPP to monitor fetal well-being -fetal movement count -non stress beginning 28 weeks -fetal ecg -L/S ratio determine lung maturity

nursing management sickle cell

-assess hydration status (drink 8-10) -monitor vitals, fhr, weight gain -avoid infection -fetal well being tests -labor: rest, pain management, o2, iv fluids for hydration, close FHR monitoring postpartum: antiembolism stockings

insulin resistance

-caused by placental hormones lactogen (hPL) and growth hormone (somatotropin) increase with growth of tissue. -pancreas responds by increased secretion of insulin to combat two hormones

effects on fetus/neonate

-congenital anomaly -macrosomia from hyperinsullemia -birth trauma due to increased size -preterm birth due to hydrmanios -perinatal death due to poor perfusion/hypoxia -IUGR secondary to maternal vascular impairment -respiratory distress syndrome resulting from poor surfactant production -polycthemia -hyperbillirubinemia -neonatal hypoglycemia -subsequent childhood obesity

diabetes effect on mother

-hydramnios due to fetal diuresis caused by hyperglycemia -preeclampsia/gestational hypertension -hyperglycemia can lead to KA and still birth -preterm labor secondary PROM -UTI from glycosuria (promotes growth of yeast) -monillial vaginitus due to. glycosuria -difficult labor, c-section, post-partum hemorrhage

rubella

-increases risk for miscarriage, stillbirth, deafness, congenital cataracts, heart defects, intellectual disabilities, liver and spleen damage, LBW< skin rash at birth -droplets don't get pregnant 4 weeks after getting MMR

screening for diabetes

24-28 weeks 1-hr 75g oral glucose test (>140mg abnormal) 3-hour glucose GTT if patient fails 1 hr 1 hr <180 mg 2 hr <153 at 3 hrs <140mg 2 or more abnormal values confirm diagnosis

most vulnerable time for cardiac decompensation

28-32 weeks and first 48 post partum

When teaching a class of pregnant women about the effects of substance abuse during pregnancy, which of the following would the nurse most likely include? A) Low-birth-weight infants B) Excessive weight gain C) Higher pain tolerance D) Longer gestational periods

A

management of diabetic woman

<7% AIC -nutrition management -hypoglycemic agents (glyburide, metformin) -> dont. cross placenta -exercise increase glucose

diabetes risk factors

>35 family hx hx of LGA (>4000g) african american, hispanic, native american BMI>30 htn pregnancy or early pregnacny recurrent infections s/s glucose intolerance use of corticosteroids pcos

A 10-week pregnant woman with diabetes has a glycosylated hemoglobin (HbA1C) level of 13%. At this time the nurse should be most concerned about which of the following possible fetal outcomes? A) Congenital anomalies B) Incompetent cervix C) Placenta previa D) Abruptio placentae

A

A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which of the following would the nurse most likely include? A) Frequent handwashing B) Immunization C) Prenatal screening D) Antibody titer screening

A

A pregnant woman tests positive for HBV. Which of the following would the nurse expect to administer? A) HBV immune globulin B) HBV vaccine C) Acyclovir D) Valacyclovir

A

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that which result indicates good glucose control? A) 90 mg/dL B) 100 mg/dL C) 110 mg /dL D) 120 mg/dL

A

After teaching a group of students about the use of antiretroviral agents in pregnant women who are HIV-positive, the instructor determines that the teaching was successful when the group identifies which of the following as the underlying rationale? A) Reduction in viral loads in the blood B) Treatment of opportunistic infections C) Adjunct therapy to radiation and chemotherapy D) Can cure acute HIV/AIDS infections

A

Because a pregnant client's diabetes has been poorly controlled throughout her pregnancy, the nurse would be alert for which of the following in the neonate at birth? A) Macrosomia B) Hyperglycemia C) Low birth weight D) Hypobilirubinemia

A.

After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which of the following as being good sources of iron in her diet? (Select all that apply.) A) Dried fruits B) Peanut butter C) Meats D) Milk E) White bread

ABC

A nurse has been invited to speak at a local high school about adolescent pregnancy. When developing the presentation, the nurse would incorporate information related to which of the following? (Select all that apply.) A) Peer pressure to become sexually active B) Rise in teen birth rates over the years. C) Latinas as having the highest teen birth rate D) Loss of self-esteem as a major impact E) Majority of teen pregnancies in the 15-17-year-old age group

ACD

A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which of the following would the nurse assess? (Select all that apply.) A) Low whimpering cry B) Hypertonicity C) Lethargy D) Excessive sneezing E) Overly vigorous suckingF) Tremors

Ans: B, D, F

A group of nursing students are preparing a presentation for their class about measures to prevent toxoplasmosis. Which of the following would the students be least likely to include? Select all that apply. A) Washing raw fruits and vegetables before eating them B) Cooking all meat to an internal temperature of 140° F C) Wearing gardening gloves when working in the soil D) Avoiding contact with a cat's litter box.A

B

A group of students are reviewing information about sexually transmitted infections and their effect on pregnancy. The students demonstrate understanding of the information when they identify which infection as being responsible for ophthalmia neonatorum? A) Syphilis B) Gonorrhea C) Chlamydia D) HPV

B

A nurse is developing a program for pregnant women with diabetes about reducing complications. Which factor would the nurse identify as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes? A) Stability of the woman's emotional and psychological status B) Degree of glycemic control achieved during the pregnancy C) Evaluation of retinopathy by an ophthalmologist D) Blood urea nitrogen level (BUN) within normal limits

B

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion? A) Wide large eyes B) Thin upper lip C) Protruding jaw D) Elongated nose

B

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which of the following would be most appropriate? A) Monthly visits until 32 weeks, then bi-monthly visits B) Bi-monthly visits until 28 weeks, then weekly visits C) Monthly visits until 20 weeks, then bi-monthly visits D) Bi-monthly visits until 36 weeks, then weekly visits

B

A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? A) Rubella B) Hepatitis B C) Cytomegalovirus D) Parvovirus B19

C

After teaching a group of nursing students about the impact of pregnancy on the older woman, the instructor determines that the teaching was successful when the students state which of the following? A) "The majority of women who become pregnant over age 35 experience complications." B) "Women over the age of 35 who become pregnant require a specialized type of assessment." C) "Women over age 35 and are pregnant have an increased risk for spontaneous abortions." D) "Women over age 35 are more likely to have substance abuse problems.

C

After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching? A) "I should take my iron with milk." B) "I should avoid drinking orange juice." C) "I need to eat foods high in fiber." D) "I'll call the doctor if my stool is black and tarry.

C

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? A) "I'll basically follow the same diet that I was following before I became pregnant." B) "Because I need extra protein, I'll have to increase my intake of milk and meat." C) "Pregnancy affects insulin production, so I'll need to make adjustments in my diet." D) "I'll adjust my diet and insulin based on the results of my urine tests for glucose."

C) "Pregnancy affects insulin production, so I'll need to make adjustments in my diet."

] In preparing a class for a group of pregnant couples, the nurse includes information about possible newborn complications associated with smoking during pregnancy. Which complications will the nurse include?

Cerebral palsy Low birth weight Cleft lip and palate Sudden infant death syndrome

A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which of the following statements by the nurse would be most appropriate? A) "You'll probably have a cesarean birth to prevent exposing your newborn." B) "Antibodies cross the placenta and provide immunity to the newborn." C) "Wait until after the infant is born and then something can be done." D) "Antiretroviral medications are available to help reduce the risk of transmission

D

A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. Which drug would the nurse emphasize as being contraindicated at this time? A) Hydroxychloroquine B) Nonsteroidal anti-inflammatory drug C) Glucocorticoid D) Methotrexate

D

A nurse is providing care to several pregnant women at the clinic. The nurse would screen for group B streptococcus infection in a client at: A) 16 weeks' gestation B) 28 week' gestation C) 32 weeks' gestation D) 36 weeks' gestation

D

A pregnant woman asks the nurse, "I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby?" Which response by the nurse would be most appropriate? A) "The caffeine in coffee has been linked to birth defects." B) "Caffeine has been shown to cause growth restriction in the fetus." C) "Caffeine is a stimulant and needs to be avoided completely." D) "If you keep your intake to less than 300 mg/day, you should be okay."

D

A woman with diabetes is considering becoming pregnant. She asks the nurse whether she will be able to take oral hypoglycemics when she is pregnant. The nurse's response is based on the understanding that oral hypoglycemics: A) Can be used as long as they control serum glucose levels B) Can be taken until the degeneration of the placenta occurs C) Are usually suggested primarily for women who develop gestational diabetes D) Show promising results but more studies are needed to confirm their effectiveness

D

Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance? A) Marijuana B) Alcohol C) Heroin D) Cocaine

D

When assessing a pregnant woman with heart disease throughout the antepartal period, the nurse would be especially alert for signs and symptoms of cardiac decompensation at which time? A) 16 to 20 weeks' gestation B) 20 to 24 weeks' gestation C) 24 to 28 weeks' gestation D) 28 to 32 weeks' gestation

D

Which medication would the nurse question if ordered to control a pregnant woman's asthma? A) Budesonide B) Albuterol C) Salmeterol D) Oral prednisone

D

S/S of cardiac decompensation

SOB on exertion swellling face hands ,feet increased RR abnormal heart beat chest pain syncope with exrtion increased fatigue moist frequent cough JVD engorgement

alcohol syndrome

Spontaneous abortion, inadequate weight gain, IUGR, fetal alcohol spectrum disorder, the leading cause of intellectual disability

Neonatal Abstinence Syndrome (NAS)

a condition in which a child, at birth, goes through withdrawal as a consequence of maternal drug use

thalassemia

alpha/minor: little effect on pregnancy except mild persistent anemia beta/major: no pregnancy due to lifelong, severe hemolysis, anemia

sickle cell and pregnancy s/s

anorexia, dyspnea, malaise pallor crisis: severe abdominal pain, mucles spasms, legs pain, joint pain ,fever stiff neck, nausea vomiting

medications

atb- prevent rheumatic fever, endocarditis heparin (no warfarin) beta blockers/ calcium channel diuretics antiarrhythmics

sickle cell anemia

autosomal recessive condition from a defective hemoglobin -worsens result of stress, infection, fever, acidosis, dehydration, physical exertion, excessive cold exposure, hypoxia

pregestational diabetes

before conception

drugs for astha

budeonside, albuterol, salmeterol *oral corticosteroids are not recomended increases risk to baby, preeclampsia, diabetes, low birth weight, adrenal problems carboprost and mistropostal contraindicated

therapeutic management of anemia

compliance with drug prenatal vitamin and iron supplement (take with vitamin c no milk, coffee, tea, chocolate, high giver) -adverse effects: gi discomfort, n/v, anorexia, diarrhea, metallic taste, black stools

The nurse is caring for a pregnant woman with diabetes mellitus. Which potential fetal complications should the nurse monitor the client for as she presents for her scheduled visits? Select all that apply.

congenital malformations macrosomia respiratory disorder

s/s

coughing, chest tightness, wheezing, sob

gestational diabetes

durign pregnancy around 24th week

chronic hypertension

htn before 20th weeks or persistance >12 weeks DASH diet frequent antepartal vistis monitor for abruptio placenta, preeclampsia

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. =

hypertension obesity previous large for gestational age (LGA) infant

source of iron

meats, green leafy vegetables, legume, dried fruits, pb, meats, iron-fortified cereal

HIV/AIDS

• •HIV/AIDS: perinatal transmission and breastfeeding; oral antiretroviral drugs (Zidovudine) twice daily during pregnancy from 14 weeks until birth, IV during labor, oral syrup to newborn x 6weeks to ↓ risk of transmission by reducing viral load as much as possible. Elective cesarean birth recommended, before onset of labor and rupture of membranes. Avoid amniocentesis, episiotomy, fetal scalp monitoring, etc..

•Hepatitis B:

•Hepatitis B: (transplacental and contact with secretions during delivery)- screen all pregnant women; treat newborn of positive mother with HBIg and HBV within 12 hours after birth

assessment for nas

•High-pitched cry, hyperreflexivity, decreased sleep, irritability •Diaphoresis, tachypnea, restlessness, nasal stuffiness •Tremors, uncoordinated sucking, frequent sneezing and yawning •Drug withdrawal from narcotics, barbiturates, or cocaine; may manifest as early as 12-24 hours after birth, up to 7-10 days after delivery

herpes simplex virus

•Most often acquired at or around the time of birth through either ascending infection after ROM or contact with the virus at the time of birth • •May cause spontaneous abortion, birth anomalies, IUGR, or preterm labor. Perinatal transmission can result in severe neurologic impairment or death • •Vaginal birth is acceptable in the absence of active lesions, but if active herpetic lesions are present near or at term, a cesarean is planned • •Invasive procedures that may cause a break in the infant's skin are avoided, i.e. AROM, fetal scalp electrode, forceps, vacuum extraction • •Treatment of the mother with an antiviral agent such as Acyclovir (Zovirax), Valacyclovir (Valtrex), or Famciclovir (Famvir) should be started as soon as the culture comes back positive

Syphilis

•Syphilis: screen (VDRL) and treat with one or more injections of PCN G IM to prevent placental transmission of congenital syphilis

Varicla

•Varicella/shingles: Varicella Zoster Virus (transplacental to fetus or droplet to newborn)- caution susceptible woman about contact with the disease and Zoster Immune Globulin for exposure

withdrawal

•W = Wakefulness: sleep duration <3 hours after feeding •I = Irritability •T = Temperature variation, tachycardia, tremors •H = Hyperactivity, high-pitched persistent cry, hyperreflexia, hypertonus •D = Diarrhea, diaphoresis, disorganized suck •R = Respiratory distress, rub marks, rhinorrhea •A = Apneic attacks, autonomic dysfunction •W = Weight loss or failure to gain weight •A = Alkalosis (respiratory) •L = Lacrimation