Final Exam for OB
Final Exam for OB NSG 330
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This 13 page Study Guide was uploaded by Brieanna Phipps on Monday May 2, 2016. The Study Guide belongs to NSG 330 at University of North Carolina - Wilmington taught by Dr. Goff in Spring 2016. Since its upload, it has received 36 views. For similar materials see Maternal Infant in Nursing and Health Sciences at University of North Carolina - Wilmington.
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Date Created: 05/02/16
University of North Carolina Wilmington School of Nursing Final Exam Study Guide Spring 2016 The exam is comprised of 75 questions: 71 multiple choice questions, two “Select all that Apply” questions, and two drug calculations. Modules & Textbook Readings: Module 9: Nursing Care of the High Risk Newborn; Acquired Problems of the Newborn, Birth Trauma; Hemolytic Disorders, Chapter 34 and Chapter 36 (Read pp. 881887 and 903906; pp. 888902 Congenital Anomalies covered in Pediatrics course). Module 10: Pregnancy at Risk: Hypertensive Disorders, Chapter 27. Module 11: Pregnancy at Risk: Hemorrhagic Disorders, Chapter 28. Module 12: Pregnancy at Risk: Endocrine and Metabolic Disorders; Infants of Mothers with Diabetes, Chapters 29 & 35 (pp. 855857). Module 13: Pregnancy at Risk: MedicalSurgical Disorders, Chapter 30, Cardiac Disorders, pp. 710711; 715720. Module 14: Pregnancy at Risk: Mental Health Disorders and Substance Abuse, Chapter 31 and Chapter 35 (Substance Abuse pp. 868880). Module 15: Pregnancy at Risk: Sexually Transmitted and Other Infections; Neonatal Infections, Chapter 7 & Chapter 35 (pp. 858868). Powerpoints: High Risk Newborn High Risk Pregnancy Cardiovascular and Other Medical Problems (Cardiac only) High Risk Pregnancy Hemorrhagic Disorders High Risk Pregnancy Diabetes; Infant of Diabetic Mother High Risk Pregnancy Hypertensive Disorders High Risk Pregnancy Mental Health Disorders and Substance Abuse High Risk Pregnancy Sexually Transmitted and Other Infections; Neonatal Infections Word Document: Spontaneous Abortion Classification Table (Module 11) 1 Topics: Cardiac disease: how and when to determine classifications, activity modifications for each class, medical management, antepartum, intrapartum, and postpartum nursing management, assessment of cardiac decompensation. Functional classification of the disease is determined at 3 months and again at 78 months gestation. Class I: asymptomatic without limitation of physical activity Class II: symptomatic with slight limitation of activity Class III: symptomatic with marked limitation of activity Class IV: symptomatic with inability to carry on any physical activity w/o discomfort Antepartum NI treat infections promptly nutrition counseling cardiac meds anticoagulant therapy test for fetal maturity and well being and placental sufficiency heart surgery if needed Intrapartum NI causes the most apprehension in clients and caregivers routine assessments for all laboring women (ABGs) minimize anxiety provide guidance support women’s childbirth preparations keep head and sholders elevated sidelying position medication and supportive care epidural prophylactic abx betaadrenergic drugs such as terbutaline vaginal birth is recommended Postpartum NI monitor for cardiac decompensation first 2448 hours are the most hemodynamically difficult VS, O2, check for edema, pain, bleeding, urinary output, dietary intake, activity establish bonding with the mother and baby and help with breastfeeding compatible meds with breastfeeding 2 contraceptive counseling Cardiac Decompensation Subjective Symptoms increasing fatigue, difficulty breathing feeling of smothering frequent cough palpitations generalized edema Objective irregular, weak rapid pulse (>100) crackles at base of lungs orthopnea rapid respirations (>25) cyanosis of lips and nailbeds Placenta previa: differentiation from abruptio placenta, nursing interventions and priorities, medical management placenta is implanted in the lower uterine segment so that it completely or partially covers the cervix NI: VS fetal assessment stop bleeding blood transfusion ultrasound to see where placenta is emotional support Abruptio placenta: women mostly at risk, signs and symptoms the detachment of part or all of a normally implanted placenta HIGH RISK: maternal HTN, cocaine, blunt abdominal trauma, cigarette smoking, hx, PROM vaginal bleeding, abdominal pain, uterine tenderness, and comtractions. Incompetent cervix/cervical cerclage: discharge teaching, nursing care after procedure, when cerclage removed tx of choice for women with cervical insufficiency d/t cervical weakening bed rest for a few days after placement 3 avoid sex intil after a postoperative check watch and report signs of preterm labor, ROM, and infection go to the hospital if you have strong contractions less than 5 minutes apart, PPROM, severe perineal pressure, and an urge to push Hydaditiform mole (3 questions): clinical findings, including lab values; longterm goals, discharge teaching benign proliferative growth of the placenta where chorionic villi develop into edematous vesicles vaginal bleeding, vaginal discharge may be dark brown or bright red and scant or profuse anemia, N/V abdominal cramps may pass vesicles preeclampsia hCG levels are persistently high or rising beyond 1012 weeks gestation when they usually decline inform pts, counseling, physical and pelvic exams, weekly measurements of hCG Ectopic pregnancy: priority nursing actions, signs and symptomsruptured and unruptured, methotrexate—side effects and why used. fertilized ovum is implanted outside of the uterine cavity 3 classic symtoms: abdominal pain, delayed menses, & abnormal vaginal bleeding tha occurs 68 weeks after the last menstural period dull lower quadrant pain to sharp stabbing pain faintness, dizziness, shoulder pain, ecchymotic blueness around the umbilicus Methotrexate antimetabolite and folic acid antagonist that destroys rapidly dividing cells SE: gastric distress, N/V, stomatitis, dizziness Hemoglobin, hematocrit, WBC, & blood glucose levels of pregnant women Hgb: 11.615 Hct: 3140 WBC: 5.716.9 BG: 7577 General principles of nursing intervention for patients with bleeding determine source of bleeding, anticipate laboratory values (CBC, blood typing, coagulation) establish venous access and start fluids, O2 Spontaneous abortion: definition and specific management of each type. 4 Threatened: bleeding that occurs in the first 20 weeks of pregnancy bed rest, transvaginal ultrasounds, hCG assessment. Inevitable: cervix is dilated, but baby is not ready to come out, maybe ROM bed rest; if ROM, pain, bleeding or infection is present, terminate pregnancy Incomplete: some of the products of conception have passed (i.e. fetus, placenta or membranes) may or may not require cervical dilation and cutterage Complete: all products of conception have passed on their own suction cutterage, no intervention if uterine contractions are present to prevent hemmorrage and no infection is present Missed: fetal demise, but uterus does not expel products of conception if spontaneous evacuation doesn’t occur, pregnancy is terminated, blood clotting factors monitored, dilation and cutterage or Cytotec Septic: spontaneous abortion d/t infection immediate termination of pregnancy, cervical culture and sensitivity and abx therapy started Recurrent: 3 or more consecutive losses prophylactic cerclage if cervical insufficiency, karyotyping both partners, evaluate uterine cavity, testing woman for thyroid disease and antiphospholipid antibody Diabetes During Pregnancy: Factors affecting pregnancy outcome Glucose crosses placenta but insulin does not Dietary management of pregestational diabetes 2200 calories food distributed throughout day Changing insulin needs or requirements during pregnancy and immediate postpartum monitor BG hourly; maintain between 80120 IV rapid insulin may be necessary AVOID DEXTROSE FLUIDS most women return to natural glucose levels after childbirth 5 Maternal and fetal complications of diabetes Maternal increased risk of miscarriage fetal macrosomia HTN, preeclampsia C/S, preterm birth, maternal mortality hydraminos ketoacidosis dystocia UTI Fetal perinatal mortality rate is 3x higher stillbirth diabetesassociated birth defects birth injuries hypoglycemia at birth macrosomia hypoglycemia asphyxia and hypoxia shoulder dystocia Metabolic changes during pregnancy affecting glucose and insulin in mother and fetus first trimester high levels of estrogen and progesterone which stimulate insulin production, hypoglycemia common in diabetics that are insulin dependent, may need decreased insulin second and third trimesters “diabetogenic” where increased insulin resistance due to Human Placental Lactogen (HPL), need more insulin Medical therapy during gestational diabetes insulin glyburide (oral hypoglycemic) metformin (oral hypoglycemic) Signs/symptoms of hypoglycemia and hyperglycemia Hypoglycemia irritability hunger nervousness sweating weakness blurred or double vision dizziness or HA pale clammy skin 6 shallow respirations rapid pulse Hyperglycemia thirst N/V abdominal pain constipation dim vision drowsiness increased urination flushed dry skin weak rapid pulse acetone breath odor Antepartum, intrapartum, and postpartum management Antepartum diet self monitoring of blood glucose pharmacologic therapy fetal surveillance Intrapartum maintain BG hourly rapid acting insulin IV Postpartum OGTT low dose oral contraceptives weight loss Prenatal screening, including Glucose Challenge Test or O’Sullivan Test (normal level) and 3hour Glucose Tolerance Test. Modified 1 hr OGTT (O’Sullivan) 50g oral glucose at first visit if high risk 2428 weeks if low risk futher testing if greater than 130140mg/dl 3 hr OGTT 100g, positive if 2 or more are met: fasting > or equal to 95 1hr > or equal to 180 2hr > or equal to 155 7 3hr > or equal to 140 Infants of diabetic mothers (IDM): signs and symptoms, glucose levels, nursing actions, potential complications, including macrosomia mother’s pancreas cannot release enough insulin to deal with increased demands maternal hyperglycemia stimulates pancreas to release insulin which acts as a growth hormone macrosomia at delivery, infant is left with greater supply of insulin than needed hypoglycemia S/S of hypoglycemia jitteriness or tremors apnea tachypnea cyanosis weak cry lethargy floppy poor feeding hypothermia diaphoresis convulsions coma Hypertensive Disorders: nursing care during a seizure, signs/symptoms and nursing care for preeclampsia, blood pressure meds, postpartum meds, HELLP syndrome visual disturbances, HTN, edema, epigastric or right upper quadrant pain, HA, hyperreflexia, positive ankle clonus (hyperreflexia), seizures. monitor BP, assessment for edema, DTRs, urine collection, lab values, activity restriction, weigh daily, seizure precautions, I&O, antihypertensive meds are indicated wwhen systolic exceeds 160 or diastolic exceeds 110. Hydralizine (Apresoline) IV, most common, Labetalol (Trandate), Nifedipine (Procardia) less side effects than Hydralizine. Mag sulfate, NSAIDs with caution, laboratory diagnosis for a variant of severe preeclampsia tha involves hepatic dysfxn characterized by hemolysis (H) elevated liver enzymes (EL), and low platelet count (LP). Magnesium sulfate: drug actions, nursing assessment of therapeutic levels, subsequent interventions, side effects and signs of toxicity, nursing actions and priorities; postpartum effects of magnesium sulfate and nursing care. CNS depressant, smooth muscle relaxant, tocolytic (prevent labor), safe for healthy fetus 8 lab values 47mEq/L IVPB bolus, then maintenance SE: nausea, feeling of warmth, muscle weakness, slurred speech, decreased reflexes Toxicity: loss of patellar reflexes, respiratory depression, oliguria, decreased LOC Antidote: Calcium gluconate check BP, pulse, respiratory status, and DTRs Betamethasone (Celestone): dosage and purpose Stimulates fetal lung maturation to prevent or reduce the severity of neonatal respiratory disress syndrome 12mg IM for two doses, 24hrs apart Syphilis: effects on newborn prematurity, hydrops fetalis, failure to thrive, anemia, leukocytosis, thrombocytopenia, lesions in long bones cranium and spine, clear mucous discharge from the nose, edema, copper colored maculopapular deremal rash on the hands and soles of the feet, lesions on mucous membranes, tough cracked lesions on the lips, separation and flaking of nails and loss of hair, iritis and choroiditis, hepatits, jaundice, inflammation of the pancreas testes and colon. HIV: risks to pregnant woman, procedures that may be done to assess fetal wellbeing, how transmitted to fetus, newborn care, nursing care after client has baby Zidovudine (ZDV) reduces risk of maternalfetaltransmission 3 part tx: oral administration starting 14 weeks gestation, IV during L/D, oral to newborn up to 6 weeks of life monitor CD4+ T lymphocyte count less than 200 susceptible to opportunistic infections monitor for signs of infection, weight loss, liver or spleen enlargement avoid amniocentesis or invasive procedures fetus may contact virus through breast milk or transplacentally, but usually through vaginal birth delay injections or heel sticks until after bath give bath ASAP after delivery wash eyes before giving eye drops/ointment encourage formula feeding Heroin and Cocaine: effects on pregnant woman and fetus, effects during labor, priority nursing interventions of woman and newborn; neonatal abstinence syndrome (NAS), nursing care. Heroin: LBW, SGA, NAS, meconium aspiration, SIDS, DTRs increased, Moro reflex decreased, jittery, hyperactive, poor feeding, seizures, 9 Cocaine: limited ability to habituate to stimuli, prematurity, SGA, placental or cerebral infarctions, hyperactivity, difficult to console, hypersensitivity to noise and external stimuli NAS: withdrawal symptoms of the fetus whose mother abused drugs S/S: tachypnea, nasal flaring, chest retractions, rhinorrhea, irritability, tremors, shrill cry, incessant crying, hyperactivity, disturbed sleep patterns, seizures, hypertonicity, increased DTRs, frequent yawning, sweating, fever, abnormal feeding pattern, vomiting, regurgitation, diarrhea NI: education, social support, supportive therapy for fluid and electrolye balance, nutrition, infection control, respiratory care, swaddling, reducing stimuli, antiseizure precautions (phenobarbital or clonidine), I&O, mother interaction with baby, referrals Chlamydia, gonorrhea, GBS, Candida vaginitis: maternal signs and symptoms, treatment, effects on the fetus and newborn, care during labor Chlamydia symptoms may not be present, or spotting, discharge, or dysuria Tx: erythromycin or amoxicillin PROM, premature labor, LBW and fetal death newborns tx with erythromycin eye ointment Gonorrhea asymptomatic or nonspecific symptoms, purulent discharge, intraamniotic infection Tx: Cefixime (Suprax) onetime IM injection sepsis of newborn, spontaneous ABO, preterm birth, IUGR, PROM, postpartum endometritis newborns tx erythromycin eye ointment GBS asymptomatic, UTI, intraamniotic infection leading to preterm birth Tx: intrapartally with IV broad spectrum penicillin G immediately upon admission, again q46 hours until birth preterm, respiratory distress, sepsis, death newborn tx Pecinicillin G or ampicillin in combination with aminoglycoside; Candida Vaginitis yeasty, whitish or whitishgrey resembling cottage cheese, puritis, burning, soreness for gravid women Dx with wet slide; Tx OTC antifungal such as Nystatin for 7 days or oral Flucanazole (one dose) thrush, red tongue and mouth mucosa, thich white or creamcolored deposits on membranes newborn tx topical Nystatin to the mouth, fluconazole, miconazole 10 Fetal Alcohol Spectrum Disorders: effects on the fetus and newborn prenatal and postnatal growth restriction, CNS malfunctions, cognitive impairment, microcephaly, small eyes or short palpebral fissures, thin upper lip, flat mid face, indisctinct philitrum, IQ deficit, ADHD, diminished fine motor skills, poor speech, lack inhibition, inappropriate judgmement skills, anxiety. Thrush in Newborn: nursing assessment, treatment, feeding of newborn eradicate the organism, maintaining scrupulous cleanliness, hand hygiene, cleanliness of equipment and environment, administration of antifungals can aquire candida infection from mother if breastfeeding; tx for mother and newborn; breastfeeding can continue if mother is on antifungals Neonatal Sepsis: risk factors, nursing care and medical treatment multiple gestation, male, birth asphyxia, meconium aspiration, abnormalities of skin or mucous membranes, metabolic disorders, LBW, preterm, malnourishment, formula feeding, prolonged hospitalization, mechanical ventilation, umbilical arter catheterization or use of other vascular catheters NI: labs, antiviral medications, breastfeeding, abx, isolation precautions, suctioning secretions. Preterm infant: Vital signs; Physiologic functions and Nursing diagnoses; Priorities of care (O2, etc.); Potential complications of O2 therapy; Stimulation when having respiratory difficulty; Apnea vs. periodic breathing; Nutritional care Physiology: head disproportionately large, ruddy skin, veins visible, vernix and lanugo, few or no creases on soles of feet, less brown fat, small fontanelles, 90 degree wrist angle, extended resting posture, ear cartilage immature, scarf sign, elbow at midline Prioritories of care: maintain body temp, nutrition, reducing infection, respiratory, Complications of O2: ROP (retinopathy of prematurity) and BPD (bronchopulmonary dysplasia or chronic lung disease), resusciatation, hood therapy, mechanical ventilation, and weaning off O2 NDx: ineffective breathing pattern, ineffective thermoregulation, risk for infection, risk for imbalanced nutrition, risk for deficient fluid, risk for impaired skin integrity, risk for injury, impaired parenting, grieving. Stimulation: prone or supine, suction nasopharynx, O2, neutral thermal environment, monitor ABGs Apnea: 20 sec or longer Periodic Breathing: 510 second respiratory pauses, followed by 1015 seconds of compensatory respirations Nutrition: human milk is the best, given through gastric tubr, residual gastric aspiration, abdominal girth to assess for distention readiness for nipple feeding: rooting, sucking on finger or pacifier, RR <60, gag reflex, weight gain. 11 Gestational maturity using New Ballard Score—compare preterm to full term (textbook pp. 553555 & on Newborn Assessment video) SGA: nursing actions maintain patent airway, prevent cold stress, oral feedings ro IV dextrose, incubator, parental support, blood glucose testing for hypoglycemia, prevent from losing heat. Postterm infant: physical characteristics normal skull, but the body disproportions make it look large; dry cracked skin, firm nails, profuse scalp hair, depleted fat layers “old person” appearance, long and thin body, absent vernix, meconium staining, alert wideeyed appearance symptomatic of chronic intrauterine hypoxia RDS: types of babies at risk, symptoms, diagnosis, medical treatment, nursing assessment and interventions #1 problem in preterm infants flaring of nares, expiratory grunt, retractions, apneic spells, cyanosis, bradycardia Dx: xray revealing diffuse pattern of haziness resembling ground glass; blood studies revealing respiratory acidosis Tx: surfactant replacement, O2 administration with PEEP or CPAP, ventilation, side lying cluster care, parenteral fluids, IV access, ABGs, pH, blood glucose, blood cultures LGA and Macrosomia; possible complications, nursing actions 12 increased C/S, hypoglycemia, polycythemia (inc RBCs), increased bilirubin, birth trauma 13
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