NRSG 3302 Maternity Final Review

Maternity Final Review Nursing Process • Assess – must assess 1st before performing an intervention! • Diagnose • Plan • Interventions • Evaluate • What is the most common reportable STD in the United States? Chlamydia • Do you have to have intercourse to get an STI? Nope • What is the most common STD (overall)? HPV - vaccine 11-26, both males and females can get it • Are there any specific concerns we need to warn women about while taking Flagyl regarding consuming alcohol? Yes – the woman will get very sick if she drinks while taking Flagyl. N/V • Is there a pH difference between Candidiasis, Bacterial Vaginosis and Trichomoniasis? If so what is it for all three? Yes, BV and Trichomoniasis: pH 4.5 - abnormal, Candidiasis (fungal infection) vaginal pH won’t change • Which of the following best describes the clinical signs/symptoms of chlamydial infection in woman? a. Most women are asymptomatic – a lot of STD’s esp. in the beginning which makes it easy to transmit to others b. Most women complain of a discharge c. Most women complain of pelvic pain d. Most women complain of urinary symptoms • Mucocutaneous lesions and rash are most commonly seen during which stage of syphilis? a. Latent b. Primary – painless sore, chancre, think its an engrone hair c. Secondary d. Tertiary • Which of the STIs have an available vaccine? Hep B, HPV, Hep A (not transmitted sexually) • Do condoms protect against all STIs? No • Is HIV testing required for all pregnant women? What if women does not want to be tested? • Not required. Woman must opt out. Educate on risk of transmission to fetus. • If you had a woman who was high risk for HIV infection “opt-out” of testing – what might you educate her on? Risk of transmission to her baby. • The risk of perinatal transmission of HIV can be reduced with antiretroviral treatment. Identification in the preconception period is essential. Which of the following statements about HIV screening in pregnancy is most accurate? Pregnant women: a. Are routinely screened for HIV with all prenatal lab testing b. Must be given the option to opt out of routine HIV testing c. Must provide written consent for HIV screening d. Should be offered HIV screening in each trimester Diseases Symptoms Pregnancy/ Risk Treatment Bacterial Vaginosis Bacteria - Watery gray discharge - Possible fishy odor - Test: Clue cells seen on wet mount - pH change! PROM Preterm Labor Infection Nonpg: Flagyl* PO x 7days/PV x5 days Pg: Flagyl* or Clindamycin PO x 7days Avoid sexual intercourse Trichmoniasis Parasite Gonorhhea -asymptomatic -yellow/ greenish discharge -swelling and inflammation of cervix -eye treatment for newborn -treated with antibiotics -partner need to be treated - Possibly asymptomatic - yellow, green frothy, malodorous discharge - Pain during intercourse - Strawberry red marks on cervix PROM Preterm Labor Nonpg: Flagyl* (no alchohol) Pg: Flagyl* Treat partners Chlamydia Bacteria *Leading cause of infertility - Commonly asymptomatic - Thin, mucopurulent discharge - Burning and frequency - Lower abdominal pain - Test: NAAT Newborn eye infection if exposed (chlamydia is most common cause) PID-blocked fallopian tubes resulting in ectopic pg Infertility Nonpg: Azithromycin 1gram x1 OR Doxycycline^^ x7 days Pg: Azithromycin 1 gram No intercourse for 7 days Treat partners Repeat test-of-cure after 3 wks(pg) Screen urine in women 25, at risk, or pregnant Gonorrhea: Bacteria - 80% asymptomatic (~all pg screened) - purulent, greenish, yellow discharge - Swelling/inflammation of vulva/cervix Newborn eye infection if exposed Nonpg – risk of Pelvic Inflammatory Disease (PID) Ceftriaxone/Rocephin 250mg IM plus Azithromycin 1 gm PO Newborn: erythromycin oint No intercourse for 7 days Treat partners Verify cure Herpes Simplex Virus Recurrent lifelong disease - Painful blisters/vesicles - Flu like symptoms - unpredictable recurrence Newborn infected No cure Acylovir/Valacyclovir PO as suppression in third trimester Outbreak = C-section Human Papilloma Virus New Vaccine (11-26) - Soft grayish cauliflower- like lesions(genital warts) - May cause itching - be friable(bleed), painful Cervical cancer No single treatment Nonpg: Podofilex solution Cryotherapy Gardisil vaccine 3 doses within 6 month time period Syphilis Bacteria All pg tested Stages of disease Primary – Chancre lesion x 4wks weight loss, fever Secondary – contagious condyloma Latent – no s/s Tertiary- tumors, memory loss Intrauterine growth restriction (IUGR), preterm birth, stillbirth Early syphilis – Penicillin G x1 Long duration – Penicillin IM once a week for 3 weeks Spontaneous Abortions • Threatened – unexplained bleeding, cramping, or backache indicate that the fetus may be in jeopardy. Bleeding may persist for days. The cervix is closed. Maybe followed by partial or complete expulsion of pregnancy, or it may resolve without threatening the fetus. • Imminent (inevitable) – Bleeding and cramping increase. The internal cervical os dilates. Membranes may rupture. Cervix is open, membranes could rupture, fetus can come out. • Incomplete – part of the products of conception are retained, most often the placenta. The internal os is dilated. Cervix open • Complete – all the products of conception are expelled. The uterus is contracted and the cervical os maybe closed. Open or closed cervix • Missed – The fetus dies in utero but is not expelled. Uterine growth ceases, breast changes regress, and the woman may report brownish vaginal discharge. The cervix is closed. If the fetus is retained beyond 4 23 wk is fetal autolysis results in the release of thromboplastin and DIC may develop • Habitual (Recurrent) – abortion occurs consecutively in 3 or more pregnancies. • Early Loss: Spontaneous Abortions (miscarriages) • 8- ‐30% of all pregnancies end in miscarriage; most in first trimester; • Less than 20 weeks • Rate of miscarriage is higher, but they never realize they are pregnant • Early Causes (12 wks): • Chromosomal abnormalities • Maternal Endocrine disorders • Teratogens • Immunologic factors or infection • Late Causes (12 – 20wks): • Structural problems • Bicornate uterus • Maternal age • Recreational drug use Fetal Demise (still born) • Fetal death after 20 weeks and time before birth • May occur before labor • Parents have to deal with experience and then need to wait for labor • May occur during labor • Panic and resuscitation • More grief due to absence of cry • Unable to visually bond with infant while alive • Neonatal Demise- death w/in first 28 days of life • Death within first month of life • May be due to: • Prematurity • Birth defects • Delivery trauma • SIDS