B334 OB final exam

preterm

infant born after 20 weeks but before completion of 37th week

rds, bpd, rop, meconium aspiration syndrome

what are 4 complications of a preterm infant

decreased number of alveoli, decreased/absent surfactant, weak or absent gag reflex

what are 3 causes for respiratory complications in preterm infants

respiratory distress syndrome

Caused by lack of pulmonary surfactant in premature infant
Loss of residual capacity, less perfusion, and weak respiratory effort
Decreased oxygenation, cyanosis and metabolic acidosis

tachypnea, grunting, flaring, retractions, cyanosis, hypotension, shock

7 s/s of respiratory distress syndrome and Transient Tachypnea of the Newborn (TTN) (tachypnea for baby is rr>60)

xray

how is respiratory distress syndrome diagnosed?

supportive care, ventilation, oxygenation, exogenous surfactant

what are 4 treatments for respiratory distress syndrome in an infant

ttn

Retained fetal lung fluid
affects 1-2% of all newborns

csection 24-48 oxygen gavage

Transient Tachypnea of the Newborn (TTN):
baby's born via ____________ are at a higher risk
Clears in _________ hours
Treat with ________
___________ feed/IV fluids until respirations < 60.

meconium aspiration syndrome

Meconium can travel to airways causing mechanical obstruction and pneumonia
Term and postterm (5-10% of births)

amnioinfusion

during labor, what can be done to decrease the risk for meconium aspiration syndrome

pph

what is one risk factor for meconium aspiration syndrome? (Failure to convert to adult circulation)

bronchopulmonary dysplasia

Chronic pulmonary condition caused by trauma from pressure ventilation and oxygen toxicity
Advances in providing maternal steroids (betamethasone/Celestone) and exogenous surfactant supplements in neonates, BPD mostly eliminated
RARE

pulmonary immaturity, fluid overload

what are two causes for bronchopulmonary dysplasia

retinopathy of prematurity

Complication of oxygen therapy in newborns
Premature delivery that requires supplemental oxygen causes tension and leads vasoconstriction
Hypervascularization may occur and cause capillary hemorrhages

16 42-43

Retinal vessels develop from _____ weeks until __________ weeks in normal development

neutral

__________ thermal environment: create environment where oxygen consumption is minimal but adequate so infant maintains body temperature and prevent cold stress!

postterm

Gestation that extends beyond 42 weeks

gavage oxygenation gain attachment

non-nutritive sucking
Allowing infant to suck on a pacifier during _________ feedings
May improve ____________ for NB
May decrease energy expenditure with less restlessness and add to weight _________
Promotes faster _______________

prolong labor, abnormal presentation

what are 2 injuries that cannot be anticipated until the circumstances are encountered during childbirth

erb palsy, facial nerve paralysis

what are 2 Peripheral nervous system injuries caused by birth trauma

group b strep sepsis

Most common cause of neonatal sepsis and meningitis
Acquired from mother's vaginal flora
Not all babies exposed to GBS develop disease

respiratory depression

early onset of group B strep sepsis has the primary symptom of _____________ with quick progression to shock. if not treated quickly, death can occur

1-3

Late onset of GBS Sepsis occurs _____ weeks after birth
Symptoms develop more slowly and usually involve the CNS

prophylaxis

GBS Sepsis:
Culture all moms at 35-37 weeks of pregnancy
Intrapartum antibiotics for positive cultures
Septic workup/antibiotics if symptomatic

toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex virus

when it comes to maternal infections, what does TORCH stand for?

40

neonatal hypoglycemia is when BG <________mg/dl
Severe or prolonged hypoglycemia may result in long term neurologic damage or death!

macrosomia, increased risk for birth injuries and cogenital abnormalities

Babies of insulin dependent mothers have what 2 things?

cold

__________stress results in increased metabolism to produce heat
Brown fat metabolism
as glucose stores or depleted, hypoglycemia can occur.
fatty acids and bilirubin compete for binding

hypoglycemia

cold stress can lead to what?

liver 2-5 12 10-14

physiologic jaundice:
Mainly caused by immature _________
Occurs in most infants
Worse in preterm, Asian, and native American babies
Occurs in day ______ of life
Peaks ≤______mg/dl
Decreases to adult levels by day _______

24

pathologic jaundice
Severe jaundice that presents in 1st ______ hrs
Rapidly rising Total serum bilirubin (TSB)

increased bilirubin load, decreased conjugation, impaired excretion

with pathologic jaundice, what are 3 things to consider/watch

phototherapy

Converts bilirubin to lumirubin a water soluble form that is easily excreted

fluorescent lighting, fiberoptic blankets

what are two types of phototherapy

nas

A set of behaviors exhibited by infants who were exposed to narcotics in utero

Early identification essential-what are we treating

high pitch cry, hyperreflexivity, diaphoresis, tachypnea, uncoordinated sucking, excessive mucus

what are 6 symptoms of Neonatal Abstinence Syndrome (NAS)

disaster

any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources

mass multiple

___________ casualty involves 100+ individuals
___________ casualty involves 2 to 99 individuals

natech

___________ (natural/technological) disaster: a natural disaster that creates or results in a widespread technological problem

terrorism

premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents

biological chemical

Any weapon involving a disease organism (____________ agents)
Any weapon that is designed to release radiation or radioactivity at a level dangerous to human life (___________ agents)

local

____________ government (first responders)
Responsible for the safety and welfare of its citizens.

state

___________ government (Office of Emergency Management)
Involved when a disaster overwhelms the local community's resources.

federal

___________government (Department of Homeland Security and CDC)
A single department focusing on protecting the American people and their homeland

unified national effort, deter terrorist attacks, protect and respond to nation

3 primary missions the DHS has (department of homeland security)

3

FEMA says in order to prepare there should be a _____ day supply of nonperishable foods and water per person.

nims

provides a systematic, proactive approach for all levels of governmental and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters.

fema

Mission is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards.

prevention

which stage of a disaster has the following:
Identify potential disaster risks.
Educate citizens regarding what actions to take to prepare for disasters.
Develop a plan for meeting the potential disasters identified.

authority, communication, logistics

In the Preparedness/Planning Stage: Community Disaster Planning, what are 3 things a plan must include

response

______________ stage begins immediately after the disaster incident occurs.
May include:
Shelter in place
Evacuation
Search and rescue
Staging area
Disaster triage

disaster triage

do the greatest good for the greatest number.

prepardness/planning

which stage of a disaster includes the following: Training in first aid
Assembling a disaster emergency kit
Establishing a predetermined meeting place away from home
Making a family communication plan

simple triage and rapid treatment

what does START Triage stand for?

respirations, perfusion, mental status

Triage of injured person should occur in less than 1 minute based on what 3 things

(3 characteristics of START assessment)

green

in start color coded triage tag:
______________= walking wounded(care may be delated up to 6 hours)

yellow

in start color coded triage tag:
_____________ = systemic but not yet life-threatening complications (1-2 hours)

red

in start color coded triage tag:
___________= life-threatening conditions that can be stabilized and have a high probability of survival(Immediate)

black

in start color coded triage tag:
_____________= deceased or injuries so extensive that nothing can be done to save them

black red 30

with START assessment: breathing
FIRST STEP Assess breathing
Absent-tag ________
>30 tag ________
<_______evaluate circulation

black red strong

with START assessment: Perfusion: check nail bed for capillary refill (normal within 2 seconds)
Absent-tag ________
Weak-tag _________
___________-evaluate mental status

red yellow

with START assessment: Mental Status
Fails to follow commands-tag _________
Follows commands-tag ____________
Neural check
Open your eyes
Close your eyes
Squeeze my hand

anthrax

Spore-forming bacteria
Three clinical forms: inhalation, cutaneous, GI
RX with Cipro or doxycycline
NOT contagious
Start antibiotic within 48 hours
Category A

plague

Bacterial infection
Causative agent in Black Plague
Hosts in rodents, squirrels, chipmunks, rabbits, and carnivores
Treat with doxycycline and/or Cipro
Category A

botulism

Neurotoxin
Derived from plants or animals
Acquired by direct contact, ingestion, or inhalation
NOT a bacteria
Descending paralysis
Can get from canning foods improperly
Antitoxin available at CDC
Category A

recovery

what disaster stage begins when the danger from the disaster has passed.
All local, state, and federal agencies are present in the area.

school

The healthy development of children and adolescents is influenced by many societal institutions. After the family, the ___________ is the primary institution responsible for the development of young people in the United States.

increase

Acquisition of health insurance leads to __________ in school performance

immunizations, screenings, emergency care, med admin, student records, nutrition

what are 6 health services offered by a school nurse

increases

21 states mandate sex education be taught
No research concludes that sex education in the schools ___________ sexual activity

occupational health nurse

The specialty practice that focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment

onsite

Occupational health nurses are Often the only ___________ health care professional.

one on one

________________ interaction is an important strategy for evaluating risk reduction behavior for individuals

secondary

_____________ prevention includes Conducting assessments and provide treatment and referrals
Health screenings at worksite with relative ease, minimal cost

occupational safety and health act

Employers must "furnish a place of employment free from recognized hazards that are causing or likely to cause death or serious physical harm to employees."

workers compensation act

Provide income replacement and health care for employees who sustain a work-related injury or death.
(state based)

americans with disabilities act

Employers must make "reasonable accommodations" to enhance opportunities for individuals with disabilities; prohibits discrimination on the basis of disability.

forensic

__________ nursing: application of the nursing process to public or legal proceedings and the application of forensic health care in the scientific investigation of trauma and/or death related to abuse, violence, criminal activity, liability and accidents:

sane

what subfield of forensic nursing Collects evidence and testifies as expert witness

lnc

Specialize within legal system using specialized nursing knowledge and expertise between law and health issues
Review and interpret medical records and charts and provide objective opinions based on standards of care

correctional nursing

Care for inmates
Primary goal in correctional facilities is to maintain a safe, secure, and humane environment for inmates

faith community nurse

Based on centuries-old philosophy from religious groups, nurses are applying science of nursing and caring to address the biopsychosocial health needs of individuals and groups in church congregations and faith communities

faith

___________ Factor: positive correlation between religion and health

home health care

A system in which health care and social services are provided to homebound or disabled people in their homes rather than in medical facilities

medicare

Noncertified home care agencies
Operate outside the ____________ system (services not covered with medicare)

hospice home health

Improves end-of-life care for the terminally ill
Relieves suffering throughout the illness
Supports the patient and family/caregiver through the dying process
Provides grief support to the family after the patient has died

increase 7-10 decrease

With pre-gestational diabetes..... Insulin needs ____________ throughout pregnancy & return to pre-pregnant levels within _______ days p birth (non-breastfeeding moms) or insulin needs can ______________ during breastfeeding

3 heart

with pre-gestational diabetes preconception care is KEY. Need to have blood sugar in tight control ______ months prior to pregnancy: can cause congenital _______ defects

diffusion insulin

Glucose transported across placenta by ________ during pregnancy. However, __________ does NOT cross placenta

10

at the ______th week of pregnancy fetus secretes its own insulin to counteract glucose

200 60

if a pregnant women has a blood sugar of _______ or greater she is experiencing DKA. if she has a blood sugar lower than __________ she is hypoglycemic (after delivery back to adult value of 70)

16-18 20-22 28 32

AFP at __________ weeks for higher risk of NTD (neural tube defects)
Fetal Echocardiogram at __________ weeks for congenital heart defects
Kick counts starting @ _______ weeks
NST at least x2/week starting @ ________ weeks

24-28

gestational diabetes is Screened with glucola testing between ________ weeks
If strong risk factors for DM, may test earlier in pregnancy
NO need to fast prior

Hyperemesis gravidarum

Excessive vomiting causing weight loss, electrolyte imbalance, nutritional deficiencies and ketonuria.

10 20

Hyperemesis gravidarum Begins within first _______ weeks of pregnancy and typically resolves by ________ weeks

antiemetic, vit b6, unisom

what are 3 pharmacologic methods to treat hyperemesis gravidarum

infertility

Those who have not achieved pregnancy after 1 year of regular, unprotected intercourse if they are under 35 years old

clomid

what medication can induce ovulation? (metformin can as well)

endometriosis

Inflammatory response leading to pelvic pain, dysmenorrhea, painful intercourse
The tissue that normally lines the cavity of the uterus (also called the endometrium) appears in locations where it should not be