N2 FINAL EXAM REVIEW

What type of infection is Trichomonas vaginalis

parasitic

Trichomonas vaginalis S/S

Frothy yellow-green discharge, foul odor, strawberry cervix, itching, dysuria

Trichomonas vaginalis prioritization

Prevent transmission + treat both partners.

Trichomonas vaginalis nursing care

- Administer metronidazole

- no alcohol.

- Treat sexual partner

- Teach safe sex practices

Toxic Shock Syndrome pathophysiology

Staph aureus exotoxin causing systemic shock response

Toxic Shock Syndrome s/s

Sudden fever, hypotension, rash resembling sunburn, multisystem organ involvement

Toxic Shock Syndrome diagnosis

CBC, cultures, BMP, liver enzymes

Toxic Shock Syndrome prioritization

Treat shock first, then check ABCs

Toxic Shock Syndrome nursing care

- Fluids, vasopressors

- Remove tampon/foreign object

- IV antibiotics

- Monitor renal/hepatic function

List the types of contraception

hormonal, barrier, IUD, sterile

Name the types of barrier contraception

condom, diaphragm, cervical cap, spermicide

Name the types of hormonal contraception

birth control, emergency pill, vaginal ring, injectable contraception, iud

Name the types of sterile contraception

tubal ligation, vasectomy

Which contraception method guarantees 0% chance of pregnancy and STI

abstinence

Spermicide

a chemical that kills sperm on contact

male condom

sheath that protects and erect penis and collects sperm when it is released

female condom

a lubricated synthetic pouch that lines the vagina

diapragm

a flexible, rubber disk that fits over the cervix

cervical cap

a soft silicone cap that fits over the cervix

what must you use with a cervical cap?

spermicide

How do hormonal methods of contraception work?

stops release of eggs from the ovary, thicken cervical mucus, and thins the lining of the uterus

Who are hormonal methods of contraception contraindicated in?

smokers

IUD (interuteran device)

T shaped object inserted into the uterus by a doctor

- copper: 10 years

- hormonal: 5 years

birth control implants

a thin, plastic rod containing hormones

birth control pill

standard type

- 21 days on, 7 days off

- menstruation is on the 7 off days

Components of male reproductive assessments

Testicular inspection/palpation, Hernias, Prostate exam if indicated

Red flags of male reproductive assessments

Painless lump (testicular cancer), dysuria, lesions

Components of female reproductive assessments

Menstrual history, pap smears, breast exam

Red flags of female reproductive assessments

irregular bleeding, pain, lumps, discharge

GTPAL

gravida, term, preterm, abortion, living

cardinal movements of labor

Engagement → Descent → Flexion → Internal rotation → Extension → External rotation → Expulsion

Nursing priority for cardinal movements of labor

Support positioning & monitor fetal heart tones

Oxytocin uses

Induce labor, augment labor, control postpartum hemorrhage

Oxytocin risks

Uterine tachysystole, fetal distress, uterine rupture

Oxytocin prioritization

Continuous fetal monitoring

Oxytocin nursing care

- Stop infusion if tachysystole

- Administer oxygen & reposition

Amniocentesis use

Genetic testing, fetal lung maturity

Amniocentesis risks

Infection, miscarriage, leaking fluid, bleeding

Amniocentesis prioritization

Rh-negative mothers get RhoGAM

Amniocentesis nursing care

Monitor FHR, observe for leaking fluid or contractions

Ectopic pregnancy pathophysiology

Embryo implants outside uterus, usually fallopian tube

Ectopic pregnancy s/s

One-sided pain, shoulder pain, vaginal bleeding, medical emergency if rupture

Ectopic pregnancy prioritization

Hemorrhage risk

Ectopic pregnancy nursing care

Prepare for surgery, Methotrexate if unruptured.

What is the immediate newborn care?

Warmth (dry, skin to skin), Airway clearance, APGAR scoring, Eye prophylaxis, Vitamin K injection, Cord care, ID band

Small for gestational age (SGA)

birth weight below the 10th percentile

SGA risks

Hypoglycemia, hypothermia, feeding difficulty

SGA assessment

low weight, thin extremities, prominent ribs.

SGA nursing care

Early feeds, Glucose monitoring, Maintain warmth

Postpartum Care assessment

BUBBLE-EE

BUBBLE-EE

Breast, Uterus, Bladder, Bowel, Lochia, Episiotomy, Emotions

Postpartum Care priority

watch for hemorrhage for first 24 hours

What indicates a postpartum hemorrhage?

boggy uterus, heavy bleeding

Preeclampsia symptoms

HTN, proteinuria, edema, vision changes, RUQ pain, hyperreflexia

Preeclampsia prioritization

prevent seizure

Preeclampsia nursing care

Magnesium sulfate, Monitor reflexes and respiratory rate, Prepare for birth if severe

What is the antidote for Magnesium Sulfate?

calcium gluconate

What indicates Magnesium toxicity?

decreased reflexes, low RR, decreased urine output

Placenta PREVIA

Painless bright red bleeding; placenta covers os; No vaginal exams

Placenta ABRUPTION

Painful dark red bleeding, rigid abdomen; emergency

Isotonic fluids

NS, LR

Hypotonic fluids

0.45% NS

Hypertonic fluids

D5NS, D10

Hypovolemia s/s

Tachycardia, hypotension, dry mucosa

Hypervolemia s/s

Edema, crackles, hypertension, JVD

Sodium extracellular range

135-145 mEq/L

Potassium extracellular range

3.5-5.0 mEq/L

Chloride extracellular range

98-106 mEq/L

Bicarbonate extracellular range

24-31 mEq/L

Calcium extracellular range

8.8-10.5 mg/dL

Phosphorus extracellular range

2.5-4.5 mg/dL

Magnesium extracellular range

1.8-3.6 mg/dL

Full Compensation

if pH is normal, but you have PaCo2 and HCO3 levels that are not normal

Partial Compensation

if pH is not normal and paCO2 and HCO3 levels that are out of range

Hyperkalemia S/S

hypotension, bradycardia, diarrhea, hyperactive bowel sounds, paralysis of extremities, increased DTR, muscle weakness

Hypokalemia S/S

decreased DTR, muscle cramping, flaccid paralysis, hypoactive to absent bowel sounds, constipation, abdominal distention, paralyzed intestines

Hypernatremia S/S

flush, edema, low grade fever, polydipsia, swollen tongue, nausea and vomiting, increased muscle tone

Hyponatremia S/S

seizure, coma, tachycardia, weak thready pulse, cardiac arrest

Hypermagnesmia S/S

bradycardia, hypotension, hyporreflexia, shallow respirations, hypoactive bowel sounds

Hypomagnesmia S/S

tachycardia, hyperreflexia, nystagmus, diarrhea

Hypercalcemia S/S

constipation, bone pain, kidney stones, decreased DTR, severe muscle weakness

Hypocalcemia S/S

Trousseau's sign, Chvostek's sign, diarrhea, circumoral tingling

Hyperphosphatemia S/S

trousseau's sign, chvostek's sign, diarrhea, weak bones

Hypophosphatemia S/S

constipation, decreased DTR, decreased HR and RR, increased BP

Phlebitis

redness, warmth, and pain around IV site

IV infiltration

swelling, pallor, and coolness at the site.

IV management

Check site q1h, pump accuracy, aseptic technique

pH range

7.35-7.45

PACO2 range

45-35

HCO3 range

22-26

Causes of Respiratory Acidosis

respiratory arrest, airway obstruction, pulmonary edema

Causes of Respiratory Alkalosis

pneumothorax, fever, anxiety

Causes of Metabolic Acidosis

shock, ketoacidosis, renal failure

Causes of Metabolic Alkalosis

vomiting, hypovolemia, hypokalemia

GFR

>60

BUN

10-20

Creatinine

0.6-1.2

Albumin

3.5-5

Urine specific gravity range

1.005-1.030

3 major categories of AKI

prerenal, intrarenal, postrenal