MNN Exam 4 Ch20ATICh8
HIV/AIDS risk factors
IV drug use Multiple sexual partners Maternal history of multiple STIs
Trichomoniasis Nursing Care
Identify and treat all sexual partners Educate the client regarding safe sex practices
___________ found in cigarettes causes vasoconstriction, transfers across the placenta, and reduces blood flow to the fetus, contributing to fetal hypoxia.
Nicotine
GBS Client Education
Notify the L&D nurse of GBS status Decrease the neonatal risks by being screened for GBS at 35-38 wks of gestation
Syphilis Medications
Penicillin G IM in a single dose. If the duration of the syphilis is unknown, three doses are recommended. Safe during pregnancy. Doxycycline or tetracycline orally, if allergic to penicillin as alternative therapy. Do not admin if pregnant.
_____________ is a widespread parasitic infection caused by a one-celled protozoan that may result from contact with cat feces.
Toxoplasmosis
Cocaine
Vasoconstriction, tachycardia, hypertension, abruptio placenta, abortion, prune belly syndrome, IUGR
A nurse is caring for a client who has gonorrhea. Which of the following medications should the nurse expect the provider will prescribe? A. Ceftriaxone B. Fluconazole C. Metronidazole D. Zidovudine
A
A nurse is caring for a newborn with fetal alcohol spectrum disorder. What characteristic of the fetal alcohol spectrum disorder should the nurse assess for in the newborn? A. Small head circumference B. Decreased blood glucose level C. Abnormal breathing pattern D. Wide eyes
A
A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? SATA A. Teach the client meticulous hand-washing B. Assess serum electrolyte levels of the client at each visit C. Instruct client to consume protein-rich food D. Assess hydration status of the client at each visit E. Urge the client to drink 8-10 glasses of fluid daily
A, D, E
Syphilis Client Education
Abstain from sexual contact until sores have completely healed. Partners need to be tested and treated. Adhere to safe sex practices All states have a reportable diseases list. Syphilis is a commonly reported condition. It is the responsibility of the provider to report cases of these diseases to the local health dept After treatment, report headache, fever, tachycardia, and myalgia. This could be indicative of Jarisch-Herxheimer reaction and should be reported to the provider
TORCH Client Education
Adhere to prevention practices, including correct hand hygiene and cooking meat properly. Avoid contact with contaminated cat litter. Because no treatment for cytomegalovirus exists, prevent exposure by frequent hand hygiene before eating, and after handling infant diapers and toys. A cesarean section is recommended for all clients in labor who have active genital herpes lesions or early findings of impending outbreak (vulvar pain, itching)
__________ spans the time frame from the onset of puberty to the cessation of physical growth, roughly from 11-19 yrs of age.
Adolescence
What is the procedure involved in the assessment of tuberculosis in pregnant clients?
At antepartum visits, the nurse should be alert for clinical manifestations of tuberculosis such as fatigue, fever or night sweats, nonproductive cough, slow weight loss, anemia, hemoptysis, and anorexia If tuberculosis is suspected, the nurse should anticipate screening with purified protein derivative administered by intradermal injection; if the client has been exposed to tuberculosis, a reddened induration will appear within 72 hrs A follow-up chest XR with a lead shield over the abdomen and sputum cultures will confirm the diagnosis.
Gonorrhea Medications
CDC recommends treatment for chlamydia as well for those who test positive for gonorrhea. Ceftriaxone IM and azithromycin PO
A nurse is caring for a 45-year-old pregnant client with a cardiac disorder, who has been instructed by her physician to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations? A. "You will need to be on bedrest for the remainder of your pregnancy." B. "It is important for you to rest after any physical activity in order to prevent any cardiac complications." C. "It will be beneficial if you plan rest periods throughout your day." D. "You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or SOB."
D
A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client? A. Sexual development of the client B. Whether sex was consensual C. Options for birth control in the future D. Knowledge of child development
D
Caffeine
Decreased iron absorption; increased risk of anemia
Chlamydia Medications
Doxycycline : Used as treatment, but contraindicated during pregnancy Azithromycin or amoxicillin : prescribed during pregnancy Erythromycin : Administered to all infants following delivery. This is the medication of choice for ophthalmia neonatorum. This antibiotic is both bacteriostatic and bactericidal, and thus provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis.
Chlamydia Expected Findings
Male : Penile discharge Dysuria Testicular edema or pain Female : Dysuria Urinary frequency Spotting or postcoital bleeding Vulvar itching Gray-white discharge Physical Assessment Findings: Mucopurulent endocervical discharge Easily induced endocervical bleeding Lab Tests: Endocervical swab culture of cervical discharge Urine culture specimen as alternative
Candidiasis Risk Factors
Pregnancy Diabetes mellitus Oral contraceptives Recent antibiotic treatment Obesity Diet high in refined sugars
Nicotine
Reduced uteroplacental blood flow, decreased birth weight, abortion, prematurity, abruptio placenta
What are the developmental tasks associated with adolescent behavior?
Seeking economic and social stability Developing a personal value system Building meaningful relationships with others Becoming comfortable with their changing bodies Working to become independent from their parents Learning to verbalize conceptually
Asthma is known as reactive _______________ disease.
airway
Candidiasis Client Education
avoid tight-fitting clothing, and wear cotton-lined underpants Remove damp clothing as soon as possible Avoid douching Increase dietary intake of yogurt with active cultures. If infections are recurrent or frequent, diabetes should be ruled out
Maternal use of __________ early in a pregnancy often results in fetal neural tube defects and microencephaly.
cocaine
Syphilis Risk factors
multiple partners unprotected sexual practices
Chlamydia risk factors
multiple sex partners unprotected sex
Human placental lactogen and growth hormone ___________ increase in direct correlation with the growth of placental tissue, causing insulin resistance.
somatotropin
BV Client Education
Avoid alcohol while taking metronidazole due to a disulfiram-like reaction (severe nausea and vomiting) Take all medications as prescribed Understand the possibility of decreasing effectiveness of oral contraceptives Treatment is not usually indicated for sexual partners, but this is recommended to prevent recurrence Adhere to safe sex practices
_______________ diabetes of any severity increases the risk of fetal macrosomia.
Gestational
Trichomoniasis Medications
Metronidazole or tinidazole : Orally Metronidazole is not given during the first trimester of pregnancy due to the teratogenic effects on the fetus
A nurse in an antepartum clinic is assessing a client who has a TORCH infection. Which of the following findings should the nurse expect? SATA. A. Joint pain B. Malaise C. Rash D. Urinary frequency E. Tender lymph nodes
A, B, C, E
The nurse is caring for a pregnant client who indicates that she is fond of meat, works with children, and has a pet cat. Which instructions should the nurse give this client to prevent toxoplasmosis? SATA A. Eat meat cooked to 160* B. Avoid cleaning the cat's litter box C. Keep the cat outdoors at all times D. Avoid contact with children when they have a cold E. Avoid outdoor activities such as gardening
A, B, E
A nurse is caring for a client with CVD who has just delivered. What nursing interventions should the nurse perform when caring for this client? SATA A. Assess for shortness of breath B. Assess for a moist cough C. Assess for edema and note any pitting D. Auscultate heart sounds for abnormalities E. Monitor the client's hgb and hct
A, C, D
Which should the nurse identify as a risk associated with anemia during pregnancy? A. Newborn with heart problems B. Fetal asphyxia C. Preterm birth D. Newborn with an enlarged liver
C
Chlamydia Client Education
Doxycycline might reduce the effectiveness of oral contraceptives. If continued sexual activity is desired, be aware of the sexually transmitted infection status of any sexual partners, and use a barrier contraceptive each time you have sex. All states have a reportable diseases list. Chlamydia is a commonly reported condition. It is the responsibility of the provider to report cases of these diseases to the local health dept.
Infections requiring prompt identification and treatment during pregnancy
HIV TORCH GBS Chlamydia Gonorrhea Syphilis HPV Trichomoniasis Bacterial Vaginosis Candidiasis
HPV Risk Factors
Multiple partners Unprotected sexual practices
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 order should the nurse place the priority? A. Perform a hearing screening B. Obtain a urine specimen C. Monitor growth and development D. Assess pulse rate
A
The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which should the nurse recognize as a symptom of cardiac decompensation with this client? A. Swelling of the face B. Dry, rasping cough C. Slow, labored respiration D. Elevated temperature
A
__________ results in reduced capacity of the blood to carry oxygen to the vital organs of the mother and fetus as a result of reduced quantities of RBC's or hemoglobin.
Anemia
A nurse is caring for a pregnant client who is HIV positive. What is a priority issue that the nurse should discuss with the client? A. The client's relationship with the spouse B. The amount of physical contact that should occur with the infant C. The client's plan for future pregnancies D. The need for the client to avoid breastfeeding
D
A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? A. Limiting sodium intake B. Inspecting the extremities for edema C. Ensuring that the client consumes a high-fiber diet D. Assessing for cardiac decompensation
D
TORCH Nursing Care
Monitor fetal well-being For rubella, immunization of clients who are pregnant is contraindicated because rubella infection can develop. These clients should avoid crowds and young children. Clients who have low titers prior to pregnancy should receive immunizations. Rubella vaccination is received postpartum due to the effects on fetus in utero. Clients should avoid pregnancy for 3 months after receiving the vaccine. Discuss safe sexual relations with client. Provide client with emotional support.
GBS Expected Findings
Positive GBS can have maternal and fetal effects Preterm labor and delivery Chorioamnionitis Infections of the urinary tract Maternal sepsis Endometritis after delivery Lab tests: Vaginal and rectal cultures are performed at 35-38 wks of gestation
What important instruction should the nurse give a pregnant client with tuberculosis? A. Maintain adequate hydration B. Avoid direct sunlight C. Avoid red meat D. Wear light, cotton clothes
A
A nurse manager is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses. Which of the following statements by a nurse indicates understanding of the teaching? A. "Obtain an immunization against rubella early in pregnancy." B. "Seek prophylactic treatment if cytomegalovirus is detected during pregnancy." C. "A client should avoid crowded places during pregnancy." D. "A client should avoid consuming undercooked meat while pregnant."
D
Trichomoniasis Expected Findings
Male : urethral draining, itching, or irritation Dysuria or pain with ejaculation Female : Yellow-green, frothy vaginal discharge with foul odor Dyspareunia and vaginal itching Dysuria Physical Assessment Findings : Discharge in the vaginal vault during speculum examination, which can be sampled for microscopy Strawberry spots on the cervix (tiny petechiae) A cervix that bleeds easily Lab tests : a sample of discharge is used for application to pH paper, and a wet mount and whiff test is performed. Diagnostic Procedures: Wet mount saline prep indicates the presence of trichomonads Pap smear can detect the presence of trichomonads
Trichomoniasis
STI caused by the protozoan parasite Trichomonas vaginalis; can be spread penis-to-vagina or vagina-to-vagina. If trichomoniasis is left untreated in females, it can lead to PID, which can cause infertility. All females who have clinical findings should be tested. Pregnant clients who have trichomoniasis are more likely to have preterm delivery and premature rupture of membranes.
During the assessment of a laboring client, the nurse learns that the client has CVD. Which assessment would be priority for the newborn? A. Respiratory function B. Heart rate C. Temperature D. Urine output
A
A nurse is caring for a client who is in labor. The nurse should identify that which of the following infections can be treated during labor or immediately following birth? SATA A. Gonorrhea B. Chlamydia C. HIV D. Group B Streptococcus beta-hemolytic E. TORCH infection
A, B, C, D
A nurse is admitting a client who is in labor and has HIV. Which of the following interventions should the nurse identify as contraindicated for this client? SATA A. vacuum extractor B. Oxytocin infusion C. Forceps D. Cesarean birth E. Internal fetal monitoring
A, C, E
A nurse caring for a pregnant client suspected substance use during pregnancy. What is the priority nursing intervention for this client? A. Determine how long the client has been using drugs B. Obtain a urine specimen for a drug screening C. Determine if the client has emotional support D. Provide education material on cessation of substance use
B
A nurse is caring for a pregnant client with asthma. Which intervention would the nurse perform first? A. Monitoring temperature frequently B. Assessing oxygen saturation C. Monitoring frequency of headache D. Assessing for feeling nauseated
B
A nurse is caring for a pregnant client. The initial interview reveals that the client is accustomed to drinking coffee at regular intervals. For which increased risk should the nurse make the client aware? A. Heart disease B. Anemia C. Rickets D. Scurvy
B
HIV/AIDS expected findings
Fatigue and influenza-like findings Fever Diarrhea and weight loss Lymphadenopathy and rash Anemia Lab tests: Obtain informed maternal consent prior to testing Testing begins with an antibody screening test, such as enzyme immunoassay (EIA). Confirmation of positive results is confirmed by Western blot test or immunofluorescence assay Use rapid HIV antibody test for a client in labor Obtain frequent viral load levels and CD4 cell counts throughout pregnancy
Human Papilloma Virus
HPV is the most common STI. Some types can cause genital warts (also known as Condyloma acuminata) and cervical cancers. It is spread through oral, vaginal, and anal sex (most commonly vaginal or anal routes). When large, widespread, or occluding the birth canal, genital warts can complicate a vaginal delivery. Therefore, a cesarean section can be recommended. Routine screening for females 21-65 yrs old can provide early detection. Screening should occur, even during pregnancy. During pregnancy, the lesions can expand and obscure the birth canal. This can interfere with descent of the fetus, as well as the client's ability to urinate and defecate.
GBS Risk Factors
Hx of Positive culture with previous pregnancy Positive GBS culture in current pregnancy Prolonged 18 hr or more rupture of membranes Preterm delivery Low birth weight Use of intrauterine fetal monitoring Intrapartum maternal fever 100.4* or greater
Gonorrhea
Neisseria gonorrhoeae is the causative agent of gonorrhea. Gonorrhea is a bacterial infection that is primarily spread by genital-to-genital contact. However, it also can be spread by anal-to-genital or oral-to-genital contact. It can also be transmitted to a newborn during delivery. Females frequently have no manifestations. If gonorrhea is left untreated in females, it can cause tubal scarring and can lead to PID, which can cause infertility. The CDC recommends yearly screening for all sexually active females younger than 25 years as well as older females who have risk factors (new or multiple partners). All pregnant clients at risk should be screened at the first prenatal visit and rescreened in the third trimester if at continued high risk. If left untreated, the neonate experiences ophthalmia neonatorum, which can cause blindness.
Narcotics
Neonatal abstinence syndrome, preterm labor, IUGR, and preeclampsia
Gonorrhea Nursing Care
Provide client education regarding disease transmission Identify and treat all sexual partners Admin erythromycin to all infants following delivery. This is the medication of choice for ophthalmia neonatorum. This antibiotic is both bacteriostatic and bactericidal, thus provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis. All states have a reportable diseases list. Gonorrhea is a commonly reported condition. It is the responsibility of the provider to report cases of these diseases to the local health dept.
What elements should be included during physical examination of pregnant clients with asthma?
Rate, rhythm, and depth of respirations Auscultation of lung sounds Skin color BP Pulse Evaluation for signs of fatigue
Sedatives
Respiratory problems, feeding difficulties, disturbed sleep
Syphilis
STI caused by the bacterium Treponema pallidum. Can have long-term complications if not adequately treated. 3 stages Black, Hispanic, and other racial/ethnic minority groups are disproportionately affected by syphilis in the US Can be transmitted through oral, vaginal, or anal sex, as well as transmitted to an unborn child. Though the rate of congenital syphilis has recently decreased, more cases of congenital syphilis has recently decreased, more cases of congenital syphilis are reported in the US than cases of perinatal HIV infection. All pregnant clients should be screened at first prenatal visit and rescreened in the third trimester if at high risk (live in areas with high numbers of syphilis cases, not previously tested, or had positive test in the first trimester)
Chlamydia
bacterial infection caused by Chlamydia trachomatis and is the most commonly reported STI in American women. The infection can be difficult to diagnose because the client rarely has manifestations. If chlamydia is left untreated in females, it can lead to pelvic inflammatory disease, which can cause infertility and ectopic pregnancy. The CDC recommends yearly screening of all sexually active females younger than 25 yrs, as well as older females who have risk factors (new or multiple partners). All pregnant clients should be screened at the first prenatal visit and rescreened in the third trimester if younger than 25 yrs and /or at high risk. If not treated during pregnancy, chlamydia can cause premature rupture of membranes, preterm labor, and postpartum endometritis If transmitted to the neonate, it can cause conjunctivitis and pneumonia after delivery
Candidiasis
AKA vulvovaginal candidiasis (VVC) or yeast infection is a fungal infection most often caused by Candida albicans, but non-candida albicans infections are possible. It is the second most common type of vaginal infection in the US All clients who have manifestations should be tested. During pregnancy, candidiasis is treated to relieve discomfort and prevent oral thrush in the neonate
GBS Nursing Care
Admin intrapartum antibiotic prophylaxis to the following clients to decrease transmission to the neonate. Client who has a GBS-positive screening during current pregnancy Client who has unknown GBS status who is delivering at less than 37 wks of gestation Client who has maternal fever of 100.4 or greater Client who has rupture of membranes for 18 hrs or longer
TORCH Medications
Administer antibiotics as prescribed Treatment of toxoplasmosis includes sulfonamides or a combination of pyrimethamine and sulfadiazine (potentially harmful to the fetus, but parasitic treatment is essential)
BV Medications
Metronidazole Clindamycin Probiotic lactobacilli used for prevention
Gonorrhea Risk Factors
Multiple sexual partners Unprotected sexual practices Age younger than 25, if sexually active
GBS Medications
Penicillin G or ampicillin are most commonly prescribed Admin penicillin 5 million units initially IV bolus, followed by 2.5 million units intermittent IV bolus every 4 hrs during the intrapartum period. The client can receive ampicillin 2 g IV initially, followed by 1 g every 4 hrs.
Gonorrhea Complications
Perinatal complications if left untreated Premature rupture of membranes Preterm birth Postpartum sepsis and endometritis Chorioamnionitis Neonatal sepsis
What are the effects of abuse of sedatives by the mother on her infant?
Sedatives easily cross the placenta and cause birth defects and behavioral problems Infants born to mothers who abuse sedatives may be physically dependent on the drugs and prone to respiratory problems, feeding difficulties, disturbed sleep, sweating, irritability, and fever
What are the factors the nurse should include in the teaching plan for a pregnant client with asthma?
Signs and symptoms of asthma progression and exacerbation Importance and safety of medication to fetus and to herself Warning signs: potential harm to fetus and self by undertreatment or delay in seeking help Prevention and avoidance of known triggers Home use of metered-dose inhalers Adverse effects of medications
Gonorrhea Client Education
Take all meds as prescribed Repeat the culture within 3-4 weeks to assess for med effectiveness There is a possibility of decreasing effectiveness of oral contraceptives Adhere to safe sex practices (mutual monogamy, correct consistent condom use)
BV Expected Findings
Thin, white or gray discharge with a fish-like odor, especially after sex Physical Assessment Findings : Discharge in the vaginal vault, which can be sampled for microscopy Lab Tests: Sample of the vaginal discharge applied to pH nitrazine paper Saline and potassium hydroxide (KOH) wet smear test Diagnostic Procedures: pH greater than 4.5 Wet mount saline prep, which indicates presence of clue cells Positive whiff test with release of fishy odor
Candidiasis Medications
Topical therapies recommended for use in pregnant clients Fluconazole can be prescribed as a single low dose to clients who are not pregnant or lactating Over-the-counter treatments OTC treatments, such as clotrimazole, are available to treat candidiasis and are used for 3-7 days. However, it is important for the provider to diagnose candidiasis initially.
The ______________ is the major site of involvement in the client with tuberculosis.
lung
What is the role of the nurse during the preconception counseling of a pregnant client with chronic hypertension? A. Stressing the avoidance of dairy products B. Stressing the positive benefits of a healthy lifestyle C. Stressing the increased use of vitamin D supplements D. Stressing regular walks and exercise
B
A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? SATA A. Maternal age less than 18 yrs B. Genitourinary tract abnormalities C. Obesity D. Hypertension E. Previous large for gestational age infant
C, D, E
HPV Expected Findings
Client reports bumps in the genital area that might not itch or hurt, vaginal discharge, dyspareunia, and bleeding after intercourse Physical Findings: Small warts or a group of warts in the genital area that can have a cauliflower-like appearance Abnormal changes to the cervix that can be detected by a Pap test Lab tests: Pap test with or without HPV co-testing per American Cancer Society and American Congress or Obstetricians and Gynecologists guidelines Females 21-29 yrs old should have a Pap test every 3 yrs Females 30-65 yrs old should have both a Pap test and an HPV test every 5 yrs (preferred). It is also acceptable to have a Pap test alone every 3 yrs. Females older than 65 yrs who have had regular screenings with normal results should not be screened for cervical cancer, unless they have cervical precancer, in which they should continue to be screened for 20 yrs after the precancer diagnosis Diagnostic Procedures: Genital warts are diagnosed by the provider based on appearance during physical examination Based on the Pap test result, colposcopy and biopsy can be performed to diagnose cervical precancer and cancer.
Alcohol
Growth deficiencies, facial abnormalities, CNS impairment, behavioral disorders, and abnormal intellectual development
Chlamydia Nursing Care
Instruct the client to take the entire prescription as prescribed. Identify and treat all exposed sexual partners. Clients who are pregnant should be retested 3 weeks after completing the prescribed regimen
BV Risk Factors
New or multiple sex partners Unprotected sexual practices
HIV/AIDS medications
Antiretroviral therapy (ART): All HIV positive infected clients should be treated with combination therapy. This is given orally and should be taken as soon as possible throughout pregnancy and before the onset of labor or cesarean birth. ART can cause bone marrow suppression Highly active antiretroviral therapy (HAART): Decreases the transmission to child. Intrapartum - IV zidovudine 3 hr prior to scheduled cesarean section until birth Nursing Actions - Admin zidovudine to the infant at delivery and for 6 wks following birth Client Education: Discuss HIV and safe sexual relations with the nurse Continue to use barrier protection during sexual activity to prevent further exposure to the HIV virus, which would increase the viral load. Discharge Instructions: Do not breastfeed Consider meeting with providers specializing in care of clients who have HIV All states have a reportable diseases list. HIV/AIDS is a commonly reported condition. It is the responsibility of the provider to report cases of these diseases to their local health dept.
A nurse is caring for a pregnant client with gestational diabetes. Which meal should the nurse recommend for this client? A. Baked chicken, green beans, and chocolate cake B. Pizza, corn, and orange slices C. Baked turkey, brown rice, and strawberries D. Steak, baked potato with butter, and ice cream
C
TORCH Expected Findings
Toxoplasmosis : Often no manifestations, but the client can experience influenza or lymphadenopathy (malaise, muscle aches, and flu-like manifestations) Rubella : Joint and muscle pain, rash, and fever Cytomegalovirus (CMV) : no manifestations or mononucleosis-like manifestations Herpes simples infection : findings consisting of painful blisters and tender lymph nodes Manifestations of toxoplasmosis include fever and tender lymph nodes Manifestations of rubella include rash, mild lymphedema, and fever HSV initially presents with lesions and tender lymph nodes Lab Tests : for herpes simplex, obtain cultures from clients who have HSV or are at or near term Diagnostic Procedures : TORCH screen: immunologic survey used to identify existence of these infections in the mother (to identify fetal risks) or newborn (detection of antibodies against infections) Prenatal screenings
Trichomoniasis Client Education
Avoid alcohol while taking this medication and for 3 days after treatment due to the disulfiram-like reaction that occurs (severe nausea, vomiting) Take all medication as prescribed Understand the possibility of decreasing effectiveness of oral contraceptives
A nurse is documenting a dietary plan for a pregnant client with pregestational diabetes. What instructions should the nurse include in the dietary plan for this client? A. Include more dairy products in the diet B. Include complex carbohydrates in the diet C. Eat only two meals per day D. Eat at least one egg per day
B
HPV Medications
For genital warts and condyloma acuminata: Client-applied creams, such as bichloroacetic acid (BCA), which is safe for use during pregnancy, and imiquimod, which is recommended for individuals age 13 and older who are not pregnant. Provider-administered therapy, such as trichloroacetic acid (TCA) application, which is considered safe to use during pregnancy. Podophyllin can be used but is not recommended during pregnancy Therapeutic Procedures: For precancerous changes on the cervix, the provider can perform treatments including laser therapy or cone biopsy, for a pregnant woman with an abnormal Pap that requires further follow-up, further evaluation and treatment are usually deferred until after birth.
HIV/AIDS Nursing Care
Goal is to keep CD4 cell counts greater than 500 Provide counseling prior to and after testing Refer the client for mental health consultation, legal assistance and financial resources Use standard precautions Admin antiretroviral prophylaxis, triple-medication antiretroviral, or highly active antiretroviral therapy as prescribed Encourage immunization against hep B, pneumococcal infection, Haemophilus influenzae type B, and viral influenza Encourage use of condoms to minimize exposure if partner is the source of infection Review plan for scheduled cesarean birth at 38 weeks for maternal viral load of more than 1,000 copies/mL Vaginal birth can be an option for a client who has a viral load of less than 1,000 copies/mL at 36 weeks of gestation Wear gloves when caring for the newborn after delivery Infant should be bathed after birth before remaining with the mother
Vaginal and rectal specimens of pregnant women may be cultured for the presence of ____________ bacterium.
Group B streptococcus
Gonorrhea Expected Findings
If anal lesions present: anal itching or irritation, rectal bleeding, diarrhea, painful defecation If oral lesions present: ulcerations of the lips, tender gums, pharyngitis Male: Dysuria Testicular edema or pain Penile discharge (white, green, yellow, or clear), sometimes profuse Female: Often no manifestations, but can experience: Dysuria Vaginal bleeding between periods Dysmenorrhea Physical Assessment Findings: Yellowish-green vaginal discharge Easily induced endocervical bleeding Lab tests: Endocervical culture preferred for female clients Urine cultures Anal or oral cultures
Syphilis Complications
If left untreated or undiagnosed, can be transmitted to the neonate and cause stillborn birth or congenital abnormalities Infection of the eyes (leading to blindness) or nervous system (headache, numbness, paralysis, dementia)
What are the complications in a pregnant client with hypertension?
Increased risk for developing preeclampsia Decreased uteroplacental perfusion
Syphilis Expected Findings
Primary stage : The client can notice a chancre, which is a painless papular lesion at the site of infection. Chancres can progress to an ulcerated area. Female report of inguinal lymph node edema can indicate internal lesions (vaginal or cervical) Secondary stage : Client can notice skin rashes, such as maculopapular rash on the palmar surface of the hands and soles of the feet Tertiary stage : Damage to internal organs can occur for which clients can notice the manifestations including difficulty coordinating muscle movements and blindness Physical Assessment Findings: Primary stage : Provider can observe a chancre in the genital area Secondary stage : Provider can observe skin rashes, such as rough, red or reddish brown spots on the palms of the hands and soles of the feet and lymphadenopathy Lab tests : Serology tests: nontreponemal (VDRI, and rapid plasma reagin) and treponemal (enzyme immunoassay, immunoassays) Nontreponemal tests are often used for screening, then treponemal tests for detecting antibodies specific for syphilis to confirm the diagnosis This sequence of nontreponemal then treponemal tests is considered the standard for testing Microscopic: Examination of primary lesion
TORCH Risk Factors
Toxoplasmosis is caused by consumption of raw or undercooked meat or handling cat feces. Manifestations are similar to influenza or lymphadenopathy Other infections can include hepatitis A and B, syphilis, mumps, parovirus B19, and varicella-zoster. These are some of the most common and can be associated with congenital anomalies. Rubella (German measles) is contracted through children who have rashes or neonates who are born to clients who had rubella during pregnancy. Cytomegalovirus (member of herpes virus family) is transmitted by droplet infection from person to person, through semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood. Latent virus can be reactivated and cause disease to the fetus in utero or during passage through the birth canal. HSV is spread by direct contact with oral or genital lesions. Transmission to the fetus is greatest during vaginal birth if the client has active lesions.
TORCH infections
Toxoplasmosis, hepatitis, rubella virus, cytomegalovirus, herpes simplex virus are known collectively as TORCH infections, a group of infections that can negatively affect a client who is pregnant. These infections can cross the placenta and have teratogenic effects on the fetus. TORCH does not include all the major infections that present risks to the mother and fetus. Rubella can cause fetal consequences (miscarriage, congenital anomalies, death) HSV can cause miscarriage, preterm labor, and intrauterine growth restriction
HPV Client Education
Vaccines are recommended to protect against low-risk types of HPV that cause genital warts and high-risk types of HPV that cause cancer. The vaccine is indicated for ages 9 to 26 yrs old, though ideally given at age 11 to 12 yrs. Three doses of the vaccine will be received during a 6-month period. Consider abstinence or safe sex practices (mutual monogamy, correct consistent condom use) If therapy is deferred until after delivery, remember that the lesions are infectious
Candidiasis Expected Findings
Vulvar and vaginal pruritus, painful urination due to the excoriation from itching Physical Assessment Findings: Speculum examination: thick, creamy, white cottage cheese-like vaginal discharge Vulvar and vaginal erythema and inflammation White patches on vaginal walls Lab Tests: Sample of discharge used for application to pH paper Saline and potassium chloride (KOH) wet mount smear Diagnostic Procedures: pH less than 4.5 (normal pH) Wet mount potassium hydroxide prep, which indicates presence of yeast buds, hyphae pseudohyphae
Bacterial Vaginosis
bacterial infection most commonly caused by Haemophilus vaginalis or Gardnerella vaginalis. It is the most common vaginal infection in females 14-49 yrs of age. It cannot be related to sexual activity. It is related to reduction in the lactobacilli in the vaginal flora. If BV is left untreated, it can increase a woman's chances of developing PID, which can lead to infertility All clients who have manifestations should be tested. Treatment is especially important for pregnant clients. BV can cause preterm labor and preterm birth.
Group B Streptococcus
bacterial infection that can be passed to a fetus during labor and delivery. Expected part of the vaginal flora for nonpregnant clients, and present in some who are pregnant. Can cause pneumonia, respiratory distress syndrome, sepsis and meningitis, if transmitted to the neonate.
HIV
retrovirus that attacks and causes destruction of T lymphocytes. causes immunosuppression Clients who are severely immunosuppressed develop AIDS HIV is transmitted from mother to a neonate perinatally through the placenta and potentially through the breast milk Routine lab testing in the early prenatal period includes testing for HIV. Early identification and treatment significantly decreases the incidence of perinatal transmission Testing is recommended in the third trimester for clients who are at an increased risk. Rapid HIV testing should be done if a client is in labor and their HIV status is unknown. Procedures such as amniocentesis and episiotomy should be avoided due to the risk of maternal blood exposure Use of internal fetal monitors, vacuum extraction, and forceps during labor should be avoided due to the risk of fetal bleeding Newborn admin of injections and blood testing should not take place until after the first bath is given If the client is HIV positive and taking antiviral meds, they should be informed that they can transmit infection to the neonate
