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NUR124 EXAM 2
nur 124 exam 2
| Question | Answer |
|---|---|
| type one diabetes | no insulin, age 20 and below |
| type two | insufficient insulin receptors,have insulin, age 40 and up |
| fetal risks of diabetes | spontaneous abortion,stil birth, lethal congenital malformation, shoulder dystocia, birth injuries, dont produce surfactant |
| maternal risks of diabetes | preeclampsia, progression of retinopathy, infections. obstructed labor |
| best time to excersise | after meals BS is rising |
| infant BG should be | above 50 |
| after birth baby still produces in excess of insulin to take care of in excess of glucose that has now stopped resulting in decreasing glucose after birth | |
| breast feeding decreases glucose in mom | |
| 28 wks estrogen, progesteron and HCl decrease insulin productionto allow more glucose for baby. Allows mom to have more energy for growing fetus | |
| failure to progress | bad contractions, bad passage |
| hypotonic dysfunction contractions | too weak from extended uterus, analgesia, anesthesia, bad pelvis |
| a pregnancy that ends before 20 wks and 500g wt, no surgical/medical intervention | spontaneous abortion |
| slight spotting, cramping, no passage of tissue, no dialation | threatened abortion |
| open cervical os, heavey bleeding, severe cramping, expulsion of fetus, retain placenta | incomplete abortion |
| expulsion all fetal tissue, cervix closed, light bleeding/cramping | complete abortion |
| tx for both incomplete/complete | dilation curettage. D n C |
| fetus died with conception products retained | missed abortion, tx medica/sirgocal termination |
| fertilized ovan attaches outside of uterus | ectopic preg, tx surgical removal, methotrexate for absorption of preg |
| ectopic preg causes | inf, scaring of falopian tubes causing more ectopic pregsz |
| eggs nucleus is deactivated, sperms nucleus replicates. resembles a unch of grapes | hydatidiform mole, tx pass on own or suction curettage. seem preg w hcg levels |
| placenta implanted in lower section of uterus | placenta previa |
| premature separation of placenta | placenta abruption |
| signs of placental previa | bleeding aftter 20wks, vs normal, tx ultrasound for placental placement, no vag exam, <36wks no activity monitor, at term c-section |
| risk factors for placental abruption | maternal hypertension, cocaine, |
| signs of placental abruption | bleeding, ab pain, contraction hypertonis, abn FHR increases, maternal hypovolemia/shock inc HR, dec BP, tx: amild prior 36wks=observation, if bad birth now |
| cure for gestational hypertension | birth |
| vasospasm that impeedes blood vlow to all the organs and increses BP. | preeclampsia |
| signs of preeclampsia | bp > 140/90 on 2 separate takings > 2hr apart, proteinuria 2 takings 6hr apart |
| used to prevent convulsions caused by pre and eclampsia. decreases neuromusclur irritability. dec contractions for preterm labor | magnesium sulfate |
| anecdote for magnesium sulfate | calcium glutenate |
| therapuetic level of magnesium sulfate | 4-8, always ngo through IV pump |
| produced by breakdown of red blood cells | bilirubin, toxic to body |
| unconjucted indirect bilirubin is released , not water soluable, liver changes it to conjucted direct by conjugation now can be excreted. | |
| excess unconjucted indirect bilirubin absorbed subQ tissue causing yellowing | jaundice |
| staining of tissues of brain causing permant damage | kernicterus |
| jaundice occuring p 24hr stopping in 7 days or 48hr p birth for 9 days | physiological jaundice, unconj bill<= 12,direct bil <= 1.5, |
| jaundice more likely to cause brain damage, shows before 24hr and lasts for 7-10 days | pathologioc |
| tx for jaundice | feeding, phototherapy, eye protection, hydration, no lotions, check temp |
| TORCH | toxoplasmosis, other, rubella, cytomeglovirus, herpes |
| virus in mom from cat feces, uncooked meat, causes swollen glands fatigue, muscle pains | toxoplasmosis |
| virus in fetus/nb toxoplasmosis | abortion, asymptomatic at birth, neurologic damage years later |
| TORCH "other" | HIV, hepatitis B, gonorrhea, parvovirus B19, syphilis, varicella |
| HIV | mom=decrease immune, nb=asymptomatic at birth |
| Hepatits B | mom=v, ab pain, jaundice, fever, rash, painful jts; nb=HBiG at birth, hepatitis B vac at birth and scheduled |
| parvovirus B19 | older children 5th desease, during preg inf results in miscarriage, hydrops, internal uterine growth retardation, anemia |
| moms w HIV | cannot breat feed, keep membranes intact, c-sec, will give med during labor to prevent transmission |
| group B strep | causes neonatal sepsis, vag/rectal culture at 34-36wks, penicillian drug choice |
| rubella | droplet contact, nasopharyngeal secreation, immune=1:8>, live MMR vac give w/i 15 mins of draw up subq, DO NOT GET PREG W/I 28 DAYS. |
| rubella | mom=rash, fever, malaise, nb=worse in 1st tri, deafness, cataracts, heart defects, retardation |
| cytomeglovirus | form of herpes, in urine, saliva, vaginal secretions, semen, breast milk, feces, common in daycares, use good hand hygene |
| cytomeglovirus effects | mom=asymptomatic, cold symptoms, no tx, nb=most asymptomatic, deafness, blindness, seizures, retardation, some symptoms dont show for years |
| herpes | mom=vesicles/shallow ulcers, crust over in genital areas, if active during labor=c-sec, tx=acyclovir during preg, nb=mortality rate w/o antiviral 25% |
| aspiration of amniotic fluid to test lung maturity 2/3 tri | amniocentesis, good lungs= 1:2, need consent |
| inj used to decrease contractions | tribulitine, breatherine |
| maternal serum triple/quad screen | test for downs, neural tube defects, trisomy 18, AFP, 16-18 wks gest |
| NST nonstress test | 32 wks gest, for adequate oxygenation of fetus, for non movement, prior still borns, baby not growing, Need 15 beats above base x 15 sec and have 2 of those in 20-30 min time period. want it to be "reactive" |
| CST contraction stress test | after 34 wks, IV pitocin/nipplen stim; reg=good no decelerations w or wo contractions, pos=bad decelerations w contractions. need to deliver soon, c-sec, baby cant tolerate contractions |
| biophysical profile BPP | NST=2(reactive), ultrasound 2pts for each..fetal movements, FHR, fetal resp, amniotic fluid index (AFI) 8-10=normal, <6 need to deliver |
| dep-provera | inj progesterone q 11-13wks, doesnt effect lactation, lose bone density, delays fertility 18th after quitting, take w vit D, hair loss |
| essure | implants into fallopian tube results in scarring 99% effective |
| implanon | preogestin continous release, rod in place x3yrs, irregular bleeding, reversible |
| ortho evra | patch, chnage q wkx3wks, 1wk patch free, |
| nuvaring | releases med continously, insert sun p menes remove in 3wks, ring free 1wk, vag irritation |
| oral contraceptives | synthetice estrogen, progesterone, supresses ovulation, protects against ovarion/endometral cancer, decreases effectiveness of antiterburculosous drugs, anticonvulsants, antifungals, anti HIV |
| intrauterine contraceptives, mirena | inplace all times, long erm low cost, reversible, can b expelled wo knowledge, increases pid, |
| chemical birth control barriers | spermicidal and foam |
| hormonal barriers | OCPs, inj, transdermal, vaginal, |
| mechanical barriers | condum, IUD, diaphragm, cervical cap, sponge |
| clamydia | yellow dc, painful urination tx: both partners |
| gonorrhea | bacterial gr- diplococcus, direct contact w inf mucosa, vag dc, dysuria, tx: cephalosporins |
| trichomonas | vag inf by protozoa, yellow-green dc, itching, strawberry cervix tx: flagyl, no ETOH |
| syphilis | painless shankers, any tissue, treponema pallidum spirochette, contact, penicillian |
| HSV1 | oral, sunlight triggers them |
| HSV2 | genital |
| postpartum hemorrhage | vag-500ml, c-sec 1000ml |
| causes of hemorhage | uterine atony,trama, placental fragments, terus not returning to normal size |
| assessment of hemorhage | check fundus, void, remove clots, bleeding, vitaql signs, |
| hemorrhage drugs | |
| Pitocin | |
| methergine | contraomdocated in hypertension |
| carboprost (HEMABATE) | prostoglandin used in extreme cases |
| cytotec | now used more than methergine |
| inf of hte uterine lining | metritis |
| perineal or if c-sec could ber incisional | wound inf |
| caused by staph aureus or e coli, spread by moms hands staff or babys mouth | mastitis |
| LAS | inflammation at the site with drainage. Pain at site. foul smelling urine. inflamed berasts |
| GAS | temp 100.4 or higher, WBC above 20,000. aching and flu like symptoms |
| PGAS | states feels unable to cope |
| transient. doesnt seriously afffect mothes ability to give care tgo nbor herself | postpartum blues |
| difficulty taking care of herself or nb. irritability | postpartum depression |
| very serios, delusional, manic, poor judgemenmt | postpartum psychosis |
| obstruction of airway causing pneumonitis | meconium aspiration |
| lack of surfactant production | resp distresstransient tachypnea, babys resp symptom get worse |
| failure to progress | contraction probs, passage prob |
| coordinated, but wek infreqeunt and brief contractions | hypotonic dysfunction from overextended uterus, analgesia |
| artificial rupture of the amniotic sac | amniotomy-probs prolapse cord, inf |
| increase effecticveness of contractions that are already present | augumentation |
| contractions are not present. causing contractions to occur | inductions |
| head is born, anterior shoulder cannot pass under pubic arch | shoulder dystocia |
| rapid acting insulin | onset: wi 15 min, peak: 2-3hr, dur: 3-4hr |
| short acting insulin | onset: 30 min, peak: 3-4hr, dur: 6-8hr |
| intermediat acting | onset: 2-4hr, peak: 4-12hr, dur: 12-24hr |
| long acting | onset: 3-4, peak: 14-24, dur: 24-36hr |
| best time to excersie is after meals, BS is rising | |
| 1hr glucose test | >140 |
| 3hr glucose test | >100 |
| maintain BG level at 110 |
Created by:
vstein
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