Exam 1: Review

A female pt has just been dx w/ condylmoata acuminate (genital warts). What information is important to tell this pt?

HPV puts her at risk for cervical cancer, and she should have a pap smear annually

A male pt has been dx w/ gonorrhea. What symptom probably cause him to seek medical attention?

foul smelling discharge

A 22 y/o is having a pap smear, an abnormal result may imply infection w/:

HPV

Which test is used to dx the basis of infertility done during the luteal or secretory phase?

endometrial biopsy

A couple is trying to cope w/ an infertility problem. What could the nurse suggest to try and keep emotional equilibrium?

a support group

Braxton hicks:

painless; relieved w/ hydration and walking

Presumptive signs:

can only be reported by the pt, they are subjective

Examples of presumptive signs of pregnancy:

amenorrhea, nausea and vomiting, urinary frequency, fatigue, breast tenderness and changes (Montgomery’s glands), quickening

Quickening:

when a pt says they can feel the baby move

Probable signs of pregnancy:

objective indicators observed by the examiner

Examples of probable signs of pregnancy:

Goodell’s sign, Chadwick’s sign, Hegar’s sign, Ballottement, enlargement of uterus or abd, pigmentation of the skin, positive pregnancy test, Braxton Hicks contractions

Goodell’s sign:

softening of the cervix

Chadwick’s sign:

blue/purplish color change of the cervix and vaginal mucosa

Hegar’s sign:

softening of the uterus

Ballottement:

passive movement of the unengaged fetus

Positive signs of pregnancy:

attributable only to the presence of a fetus

Examples of positive signs of pregnancy:

ultrasound, fetal heart tones heard, fetal movement felt by a dr

A pt tells you she wants to start tracking her ovulation, and she asks how she will know how she is ovulating. The nurse responds with:

you will have an increase in basal body temp (2 days before and 2 days after)

If syphilis isn’t tx before week _ in the infected mother, it can be transmitted to the fetus:

18

Syphilis in a pregnant woman is tx with:

penicillin

A 38 week pregnant woman comes in with SOB and a hx of asthma. As the nurse, how can you educate her?

take your prescribed asthma medications when necessary; if she is taking them and she’s still having SOB she should follow up with her physician

What is the infant at risk for if the mother has syphilis?

low-birth weight, stillbirth, death, IUGR, prematurity, and hydrops

Considerations for mothers with HIV:

cannot breastfeed, usually a C-section is suggested to prevent transmission to the baby

Why is it important to screen for STI’s during pregnancy?

prevention is necessary → STIs can cause fetal complications, routine screening aids in early detection and tx

A pt is complaining of fatigue, CBC says hgb is 9.7/dL. What education should the nurse provide?

make sure to drink 6-8oz of water/day, eating meals high in protein (milk, chicken, beans, nuts)

A pt is experiencing supine hypotension, what is the best action for the nurse to take?

turn the pt on their left lateral side

Side effects of Clompihene:

mood swings

What is the priority nursing action for hysterosalpinogram?

determine if the pt has allergies

A pregnant woman is coming in 6 weeks pregnant. What are important education topics the nurse should go over?

the dangers of vaginal bleeding

What occurs during the secretory phase of the menstrual cycle?

ovulation

A pt comes in w/ dysmenorrhea, why is the pt experiencing this?

prostaglandins are being released causing painful cramping

Tests taken during the first prenatal appointment include:

folic acid, STI panel, VDRL, blood type and Rh factor, CBC, HIV, sickle cell, cervical cancer

During a prenatal screening, the mom tests positive for CF. Should the dad now be tested?

yes

What type of hx do you take on a new pt for the first prenatal visit?

fam hx, immunizations, pre-existing conditions, environmental hazards, gynecologic hx

What is considered advanced maternal age?

35+

What are risks for a woman who is pregnant and of advanced maternal age?

risk for Trisomy 21 (Down syndrome), 18 (Edwards syndrome), 13 (Patau syndrome) → all increase exponentially

Trisomy 21:

Down Syndrome

Trisomy 18:

Edwards Syndrome

Trisomy 13:

Patau syndrome

A pt is taking an estrogen-progestin therapy drug for a reduction of menopause symptoms. What are they at risk for long-term?

breast cancer

A pt comes in for their first prenatal visit, and they’re not immune to rubella. As the nurse, what education should you provide the pt?

stay away from anyone that may have rubella, including children

You are obtaining a FHR by Doppler, rate i 95 bpm. What should you do?

check the HR against the moms

A pt is in for a prenatal visit and has elevated BP, and during the last visit they had an elevated BP. What should the nurse do?

check the cuff size

What foods should a pt eat to increase folic acid intake?

leafy green veggies, eggs, asparagus, citrus fruits, beans, peas and lentils, avocado, okra, Brussel sprouts, seeds and nuts

Proliferative phase of the uterine cycle:

7-14 days

End of menses thru ovulation, estrogen levels are low at the beginning and gradually increase, enlarging endometrial glands, growth of uterine smooth muscle, progesterone develops

Secretory phase of the uterine cycle:

15-16 day

Time of ovulation

Prior to menses, progesterone increases creating highly vascular endometrium that is suitable for implantation of a fertilized ovum, endometrial growth ceases, number of estrogen and progesterone receptors decrease, progesterone also causes → increased glandular growth of breasts

Integumentary system changes during pregnancy:

skin stretches, changes in pigmentation (linea nigra, cholasma), hyperactive sweat and sebaceous glands, striae gravidarum, angiomas, palmar erythema, new hair growth, stronger nails

Lifestyle choices for women trying to become pregnant and newly pregnant women:

exercise, seatbelt above stomach, cessation of smoking and alcohol and caffeine and artificial sweeteners

As the nurse, what do you educate a woman during a prenatal appointment about weight and nutrition?

increases calories by 300, weight depends on BMI, 8-10oz glasses/day (4-6 should be water), protein, vitamins and minerals, calcium and vit. D, iron, vit. C, folic acid

If a woman gains too much weight during pregnancy, what could happen?

pre-eclampsia, gestational diabetes, c-section, baby could be macrosomia (overweight)

A pregnant woman asks about what meds she can take during pregnancy. As the nurse, how do you respond?

OTC - acetaminophen, guaifenesin; AVOID herbal teratogens, and teratogens

Common discomforts during pregnancy:

round ligament pain, nausea and vomiting, SOB, stuffy nose, ptyalism, dyspepsia, flatulence, constipation, backache, dependent edema, varicosities, leg cramps, leukorrhea, urinary frequency, dyspareunia, nocturia, supine hypotensive syndrome

What are some s/s of danger r/t pregnancy that you should educate your pts on:

bleeding color, how much; pain

1st trimester dangerous s/s:

nausea and vomiting, dehydration; bleeding - spontaneous abortion, pain, emotional support; infection - notify MD

2nd trimester dangerous s/s:

pre-eclampsia: one of the most common

PROM - notify MD, infection risk

pre-term labor → fetal well-being is a concern

3rd trimester dangerous s/s:

same as second; gestational diabetes → fetal well-being is a concern, type 2 diabetes risk for mom; bleeding → placenta, bright red and not painful, abruptio placentae → dark red and painful

A pt comes in w/ unilateral pain, abd tenderness, and vaginal bleeding. As the nurse you expect an ectopic pregnancy, you should do what?

send the pt for an ultrasound to confirm dx, and obtain CBC

What is a hydatiform mole (molar pregnancy)?

abnormal placental development that results in the production of fluid-filled grapelike clusters instead of normal placental tissue

What are the s/s of a molar pregnancy?

bleeding, early elevation of BP, abnormally high HCG for gestation

Molar pregnancy dx:

ultrasound

Molar pregnancy management:

removal of uterine contents, follow up HCG levels

Molar pregnancy education:

no pregnancy for 1 y bc of spontaneous abortion likely to occur

Spontaneous abortion:

before 20 weeks, pregnancy ends spontaneously; s/s → bleeding, cramping, passing of tissue; dx → ultrasound, low HCG; management → dilation and curettage (D&C)

Hyperemesis Gravidarum:

extreme persistent nausea and vomiting

Hyperemesis Gravidarum s/s:

profuse vomiting, weight loss

Hyperemesis Gravidarum maternal and fetal effects:

maternal depression, intrauterine growth restriction (IUGR)

Hyperemesis Gravidarum management:

IV fluids, pyroxidine hydrochloride (vit. B, doxylamine, succinate, promethazine)

Placenta Previa:

placenta covers the cervix bc it’s implanted in the lower uterine segment

Placenta Previa s/s:

bright red bleeding, painless; reoccurs spontaneously

Placenta Previa dx:

ultrasound

Placenta Previa management:

education and monitoring, no vaginal exams, may include immediate delivery (c-section bc it can cause bad things for mom)

Placental abruption:

placenta separates from the uterus → complete requires immediate delivery

Placental abruption s/s:

dark red blood, painful 3rd trimester; rigid abd

Placental abruption dx:

ultrasound shows evidence of hemorrhage

Placental abruption management:

depends on size, may include immediate delivery

What would you do if a pt comes in the ED w/ a placental abruption?

start an IV first

You have a pt w/ a suspected placental abruption, what do you do?

draw labs and continuous monitor

What increases the risk for abruptio placentae (abruption)?

cigarettes, blood clotting disorders, diabetes, HTN during pregnancy, cocaine, alcohol, previous hx

Signs your pt is going into DIC?

bleeding from openings in the skin, low platelets, petechiae, purpura, GI bleeding, hypotension

Pre-term labor dx:

L&D before 37 weeks, uterine contractions, cervical dilation and effacement

Pre-term labor management:

tocolytic meds → terbutaline (slows down uterine contractions), indomethacin, nifedipine (given for elevated BP, slow down contractions), magnesium sulfate (CNS depressant, smooth muscle relaxant, seizure precautions)

Can you give two tocolytic meds together?

NO

Pre-eclampsia:

increased BP after 20 weeks, protein in urine

Pre-eclampsia management:

labor is the only cure; meds, bedrest, side lying, I&Os, seizure prevention, antihypertensives (alpha-methyldopa, labetolol, nifedipine, hydralazine, hydrochorlotiazide, sodium nitroprusside)

Pre-eclampsia mild s/s:

BP 140/90+, urine dipstick protein 3+

Pre-eclampsia severe s/s:

BP 160/110+, urine dipstick protein 3+; persistent or severe headache, blurred vision/visual disturbances, epigastric pain, IUGR (baby at risk for)

Meds you give for pre-eclampsia:

magnesium sulfate → CNS depressant, smooth muscle relaxant, used to prevent seizures → loading dose, maintenance dose

What lab value indicates your pt is mag toxic?

9+

Magnesium toxicity s/s:

decrease reflexes, changes in LOC, respiratory depression

Magnesium sulfate antidote:

calcium gluconate

What do you do if your pt exhibits s/s of mag toxicity?

stop the mag, give the antidote

TORCH infection:

infection causing harm to the embryo or fetus

TORCH infections can:

cause fetal defects or death

How does someone acquire a TORCH infection?

cat feces, eating raw eggs, consuming raw or undercooked/poorly cooked meat, gardening soil

What can TORCH infections do to the heart?

cause maternal hearts to become inflammed

Criteria for RHO (D) immunization:

mom Rh-, give the shot

When should pts receive the rhogram shot?

28 weeks; within 72 hrs of delivery if the baby is +

How would you educate a mom who has a baby who is Rh-?

she doesn’t require the second shot, but she’ll need it with future pregancies bc you don’t know the baby’s blood type until they’re born

First step in the tx plan for gestational diabetes:

dietary modifications, exercise

Second step in the tx plan for gestational diabetes:

monitor glucose, insulin or glyburide insulin