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2010-02-01 20:04:27
Study Guide

Test 1
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  1. motile protozoa that loves alkaline environment so he creates hydrogen which combined with oxygen creates his anaerobic environment. sexually
    transmitted. can also get this from hot tubs
  2. S&S of trichomoniasis
    asymptomatic or mild yellow green frothy dishcharge and itching of vulva. cervial hemorrhages. may also complain of dysuria and dyspareunia
  3. Dx trichomoniasis
    • microscope - trichomonads and leukocytes
    • pH 4.5 or higher
    • positive whiff test
  4. Tx of trichomoniasis
    flagyl 2gm single dose or 500mg BID for 7 days for BOTH partners. NO intercourse until treatment is complete
  5. what to look for with cervial hemorrhages in trichomoniasis
    • strawberry-like red spots (visible to naked eye)
    • smaller areas may be visible with a colonoscope
  6. When taking Flagyl, avoid?


    abdominal pain, nausea, flushing or tremors
  7. most common STD/STI in US and in LA
    Chlamydia (Chlamydia trachomatisis)
  8. S&S of Chlamydia

    thick mucopurulent discharge, friable cervix (bleeds easily), burning and frequency of urination and lower abdominal pain
  9. Dx of Chlamydia
    culture of cervical cells

    DNA probe
  10. Tx of Chlamydia

    azithromycin 1 gmorally or doxycycline 100mg PO BID x 7days

    no sex for 7-8 days (length of tx)

    pregnancy: amoxicillin or azithromycin
  11. In women chlamydia may result in?

    In men?

    newborn exposure through birth canal? (tx with?)
    PID, infertility and ectopic pregnancy

    epidiymitis and infertility

    chlamydial pneumonia; ophthalmia neonatorum(chlamydial conjuctivitis) (responds to erythromycin opthalmic oitment but not to silver nitrate eye prophylaxis)
  12. S&S of Gonorrhea

    purulent green-yellow discharge, dysuria, urinary freguency
  13. Dx of Gonorrhea
    culture of cervix, urethra, throat, rectum
  14. Tx of Gonorrhea


    ceftriaxone IM and doxycycline or azithromycin orally(dual for CZ)

    can also use oflaxacin and cipro

    treat partners even if asymptomatic and no sex until cured

    cephlosporin IM and be sure to re-culture
  15. S&S of Herpes Genitalis
    single or multiple blister like vesicle on genital area, vagina, cervix, urethra and anus
  16. Dx of Herpes Genitalis
    culture of lesion or noted on pap smear may do antibody testing
  17. Tx of Herpes Genitalis
    no cure. 1st episode give oral acyclovir, valacyclovir or famicyclovir. use in future prodromal stages and pregnancy
  18. pregnancy considerations for herpes
    do NOT deliver vaginally if vesicle are present on any portion of genital tract during childbirth; could have fatal effect
  19. caused by spirochete bacteria termed Treponema pallidum, through congenital or sexual contact or open wound, infected blood
  20. Stages of Syphilis

    primary (S&S)

    secondary (S&S)
    painless ulcer

    wartlike plaques, arthritis, liver and spleen enlargement, chronic sore throat with hoarsness
  21. Dx of Syphilis
    microscopic exam of chancre for spirochetes or VDRL or RPR or FTA-ABS (more specific)
  22. VDRL


    venereal disease research laboratries

    Rapid plasma reagent

    flourescent treonemal antibody absorption test
  23. Tx of Syphilis

    long duration?
    pregnant or nonpregnant is 2.4 million units of Benzathine penicillin G IM

    same medcian and does but given IM x 3 weeks
  24. 2nd most common STD in US; caused by human papilloma virus

    link between HPV and?
    condylomata acuminata (venereal warts or HPV)

    cervical cancer
  25. S&S of Condylomata Acuminata
    multiple or single soft, graysish, pink cauliflower like lesion in genital area
  26. Dx of Condylomata Acuminata
    sometimes biopsy but usually by visual appearance or present on pap smear
  27. Tx of Condylomata Acuminata
    podofilox solution or gel.

    cyrotherapy, liquid nitrogen, trichloracetic acid (TCA), bichloracetic acid (BCA), surgical removal, shave excision or curettage or laser surgery
  28. parasite or "crab" louse that lays eggs and attaches to hair shaft

    Pediculosis Pubis/pubic lice

    sexucal contact or linen sharing
  29. S&S of pubic lice
    itching in pubic and anal area
  30. Tx of pubic lice
    1% permethrin cream rinse to area and washing of linens

    retreatment as often as necessary

    all contacts must be treated
  31. caused by itch mite; female burrows under skin and deposits eggs
    saroptes scabiei - Scabies
  32. transmission of scabies
    sexual contact and contact with household members
  33. S&S of scabies
    itching worse at night and warmth; erythematuous paular lesions or furrows present
  34. Tx of scabies

    1% lindane (Kwell) lotion - apply and wash off 8 hrs later - WASH all clothing and linen and DRY

    Permethrin 5% in pregnancy
  35. Nursing care for STD's
    must treat partner

    pain, embarassment

    thorough sexual hx; identify patients at risk and educate
  36. instance of Pelvic Infammatory Disease (PID)
    1% of sexually active women
  37. Risk factors for PID

    multiple partners, early onset sexual activity, recent Gyn procedure, recent IUD placement, women who douche regularly

    clamydia, gonorrhea, BV
  38. S&S of PID
    bilateral sharp cramping pain in LQ, fever, chills, vaginal discharge, irregular cycles, malaise, N&V, or asymptomatic
  39. Dx of PID
    clinical exam, chandelier sign, cultures, palpable mass, laparoscopy confirms
  40. Tx of PID
    often hospitalization or treat outpatient with cefotetan plus doxycycline, clindamycin and gentamicin
  41. Nursing care for PID
    • risk factors
    • IUD use
    • assess for aching pain, foul smelling discharge, malaise, fever
    • education
  42. types of abuse
    physical, emotional, sexual, economic, social isolation, destruction, threats of violence to others, stalking
  43. common myths about abuse (7)
    • 1. battering occurs in a small percentage of the populatino
    • 2. battered women provoke men
    • 3. ETOH and drug abuse cause battering
    • 4. battered women were battered children
    • 5. they can easily leave
    • 6. domestic violence is a low-income or minority issue
    • 7. batter women will be safer when they are pregnant
  44. contribution factors to domestic violence
    • 1. childhood experiences
    • 2. male dominance in family
    • 3. marital conflict
    • 4. unemployment/low socioeconomic status
    • 5. traditional definitions of masulinity/hypernasculinity
  45. cycle of violence
    • 1. tension building phase
    • 2. acute battering incident
    • 3. tranquil phase (honeymoon period)
  46. Tension building phase
    demonstrates power and control; anger, arguing, blaming woman for external problems; possible minor battering incidents; woman feels at fault; will last from weeks to years
  47. acute battering incident
    triggered by some external event or internal state of batterer; episode of acute violence; blames woman for abuse, woman will accomodate to survive; will last few hours to a few days
  48. tranquil phase (honeymoon period)
    extremely loving, kind and contrite behaviors; making up to woman; gift buying and promises that it wont happen again; this will end and cycle will repeat
  49. S&S of abuse
    Neurologic, gynecologic, obstetric, gastrointestinal, musculoskeletal, psychiatric, constitutional, trauma and other misc
  50. neurologic signs of abuse
    headaches - including those following trauma or concussion, tension or migraine; dizziness; paresthesias; unexplained stroke from strangulation; hearing loss; detached retina
  51. Gynecologic signs of abuse
    dyspareunia (painful intercourse), STI, frequent vaginal infections; sexual dysfunction, mentrual disorders, pelvic pain
  52. obstetric signs of abuse
    late onset of prenatal care, premature labor, low birth weight of infant, excessive concern over fetal well being, recurrent therapeutic abortion, recurrent spontaneous abortion
  53. gastrointestinal signs of abuse
    dyspepsia, IBS, globus (sensation of lump in throat),
  54. musculoskeletal signs of abuse
    arthralgias (painful joints), chronic pain, osteoarthritis, fibromyalgia
  55. pschiatric signs of abuse
    anxiety, panic, PTSD, mood disorders, depression, suicide attempts, somatization, eating disorders, substance abuse, child abuse and neglect
  56. consitutional signs of abuse
    fatigue, weight loss, weight gain, mulitple somatic complaints, contusions, abrasions, sleep and appetite disturbances, decreased concentration, freqent use of pain medications or tranquilizers
  57. trauma signs of abuse
    any injury to female organs, extensive accident hx, old fractures, sexual trauma
  58. misc signs of abuse
    hx of missed appts, low self esteem (seen in woman's dress, appearance and way she relates to HCP)
  59. types of rape
    blitz (stranger), acquaintence(date), power, anger, sadistic, gang
  60. power rape
    purpose is control or mastery; places woman in powerless position; often a planned stranger attack, but most acquaintence rapes are also power rapes
  61. anger rape
    used to express feelings of rage and retaliation; considerable brutality; attacks on older women are often anger rape
  62. sadistic rape
    by antisocial person who delights in torture and mutilation; usally strangers and planned; hand in hand with homicide
  63. blitz (stranger rape)
    sudden and unexpected and more likely to threaten violence with a weapon or murder
  64. acquaintence or confidence rape
    victim has previously had a nonviolent interraction and is deceived by rapist; marital rape is included in this; most of time sex is planned but will result in rape if denied by victim;
  65. 70% of rapes are?
    acquaintence rapes (victim knows rapist)
  66. gang rape
    multiple rapist on one victim
  67. rape trauma syndrome
    cluster of symptoms in three phases:

    • acute phase
    • outward adjustment phase
    • reorganization
  68. acute phase (disorganization) of rape trauma syndrome
    • few days to 3 weeks
    • experience fear, shock, disbelief, denial, humiliated, unclean, angry, anxious, powerless, may supress her emotion or reveal them
  69. outward adjustment (denial) phase of rape trauma syndrome
    appears to be coping but is in denial and suppressing feelings; may move and take alternative security measures
  70. reorganization phase of rape trauma syndrome
    integration and recovery, silent reaction; will want to talk about rape, alters self concept and resolves feelings; may develpe phobias, sexual dysfunction and sleep disorders
  71. what would indicate a porbable ovulation in regard to basal body temp
    decrease in temp followed by an increase for several days
  72. in order to assess the origin of galactorrhea the nurse must gather what?
    color and consistency of discharge
  73. What is emergency contraception used for?
    unprotected intercourse or surprise breakage of condom or diaphragm slip or missed Depo Prevera injection.
  74. vasectomy (def)
    male sterilization through severing vas derens in scrotum
  75. how long before no sperm in vasectomy
    6 wks
  76. must check vasectomy when?
    in 6-12 mos.
  77. percentage of restored fertility with vasectomy
  78. Tubal ligation
    • female sterilization through clipping, electrocoagulation, bonding, or
    • ligation fallopian tubes preventing ovum and sperm from meeting.
  79. best time for tubal ligation
    postpartum period
  80. failure rate for tubal ligation
  81. restored fertility in tubal ligation
  82. Things to consider when choosing contraception method
    lifestyle, safety, age, cost, support of spouse, motivation
  83. method for using condoms
    tip to base roll - do NOT reuse
  84. considerations for diaphragm use
    MUST fit correctly- has to be left in for 6 hrs after intercourse- MUST be washed after each use- may be put in 4 hrs before intercourse, then reapply spermicide before
  85. how long can a cervical cap be left in ?how far in advance must a cervical cap be put in place before intercourse?
    - 48 hrs- 20 min- 4 hrs
  86. should be in a monogamous relationship with what type of contraception?must be able to feel what?
    • - IUD's
    • -string
  87. Aspects of contraceptive education
    - encourage partner participation- complete history- contraindications- cultural beliefs- bias - age- side effects- written information-follow up visits
  88. how often to do self breast exam
    once a month, one week after menses
  89. mastodynia
    premenstrual breast swelling
  90. mammography
    x-ray of breast soft tissue
  91. when to begin getting mammograms
    35 - initial appt; then annual after 40
  92. false positive mammogram most common at what age
  93. menopause
    cessation of menses for 1 full year
  94. average age for menopause; duration
    45-52; most women live about 1/3 of their life with menopause
  95. climacteric
    change of life, psychological and physical alterations occuring around time of menopause
  96. symptoms associated with menopause
    • - hot flashes (LH surge) vasomotor instability- osteoporosis
    • - changes fat distribution
    • - wrinkling
  97. treatments for osteoporosis
    HRT - elevates HDL, lowers LDL, moves Ca into bonealternative therapies
  98. changes associated with menopause
    anovulation-amenorrhea-follicle-stimulating hormone levels increase-estrogen decreases-endometrium this and myometrium, fallopian tubes, and ovaries atrophy-thinning and dryness of vaginal mucosa-vaginal pH increases-pubiv hair thins and turns gray or white-Labia shrink and lose pigmentation-pelvic fascia and muscles atrophy-breast become pendulous-changes in cognitive function
  99. nursing care for menopause
    - climacteric- psychological aspects- physical aspects- osteoporosis- HRT- counseling regarding adjustment to life- sexual questions contraception? dryness?- concern and caring, self worth, esteem
  100. osteoporosis
    decrease in bony skeletal mass associated with low estrogen and androgen levels
  101. increase risk for bone fractures in what location with osteoporosis
    hip and vertebrae
  102. risk factors for osteoporosis
    - asian-european american- small boned- thin- family history- lack of weight bearing exercise- nulliparity- early menopause- low Ca intake in teen years- cigarrette smoking- heavy alcohol intake
  103. treatment of osteoporosis
    -bone density scan- ERT if no contraindications- prevention is the most important- over age 50 needs 1200mg Ca/day- exercise- no smokding, no alcohol, no caffeine- Vitamin D
  104. the placenta is improperly implanted in the lower uterine segment, possibly covering the internal os.
    placenta previa
  105. Classic symptom of placenta previa
    painless vaginal bleeding most often after 20 wks gestation
  106. Dx of placenta previa
    by S&S and US
  107. what to check with newborn if mother has placenta previa
    H&H, cell volume and erythrocyte count; may require O2 and blood and admittance to NICU
  108. Risk for mother with placenta previa
    FVD, altered tissue perfusion, anxiety, impaired gas exchange; monitor mother and baby if bleeding persists
  109. premature separation of implanted placenta; potentially catastrophic (fetal death)
    abruptio placentae
  110. S&S of abruption
    painful uterin irritability/hard contractions; external or concealed bleeding; hard uterus; rigid ABD
  111. complications r/t abruption
    schock, DIC, hysterectomy
  112. classifications of abruption (grade 0-3)
    • Grade 0 - no S&S, clot noted after delivery
    • Grade 1 - Vag bleeding may have mild uterine tenderness, tetany, no fetal or maternal distress
    • Grade 2 - ABD tenderness/tetany, may be vag bleeding, fetal distress in 25-50%
    • Grade 3 - Tetany severe, schock, vag or concealed bleeding, may have coagulopathy >50%
  113. when there is over 2000mL of amniotic fluid.


    1% of all pregnancies
  114. chronic hydramnios
    the fluid volume gradually increases; a problem of the third trimester; most common
  115. acute hydramnios
    volume increases rapidly over a period of a few days; diagnosed betwwen 20 adn 24 weeks' gestation
  116. S&S of hydramnios if over 3000mL
    SOB and edema in the LE; intense pain
  117. Tx of hydramnios
    if severe enough - hospitalization and removal of excess fluid, can be done vaginally by AROM (not able to remove fluid slowly) or by amniocentesis
  118. AROM
    artificial rupture of membranes
  119. less than normal amount of amniotic fluid (approx. 500mL is norm)
  120. Dx of oligohydramnios
    when the largest vertical pocket of amniotic fluid visible on US is 5cm or less

    during antepartum period - when uterus does not increase in size; fetus is easliy palpated and outlined; fetus is not ballottable
  121. Fetal complications assoc. with oligohydramnios
    if occuring in the first part of pregnancy - adhesions are possible

    during gestational period - fetal skin and skeletal abnormalities may occur b/c fetal movement is impaired; pulmonary hypoplasia may develop

    during labor and birth - cord compression is more likely
  122. Tx of oligohydramnios
    fetus - can be assessed with BPP, NST, and serial ultrasounds

    during labor - monitor by continouous electronic fetal monitoring to detect cord compression

    amnioinfusion can replace some fluid volume and remove pressure on umbilical cord
  123. substance about symptoms
    • inappropriate behavior
    • angry, caustic, abusive reactions, paranoia
    • disorientation, smell of ETOH
    • inflamed nasal mucosa, excessive fetal activity and tachycardia
    • high BP, dilated or constriced pupils, diaphoresis
  124. medical risks of substance abuse
    • spontaneous abortion
    • abruption placentae
    • low maternal weight gain
    • preter labor and birth, fetal death
    • LBW, IUGR, SIDS, fetal ETOH syndrom (FAS)
    • neonatal withdrawal
    • STD's, HIV, Hepatitis, cirrhosis, malnutrition
  125. yolk sac
    forms primitive red bloods cells during the first 6 wks of embryo development until the liver takes over the process.
  126. provides oxygen and nutrients while uteroplacental cirulation is established
    yolk sac
  127. yolk sac is eventually incorporated into the
    umbilical cord
  128. amniotic cavity
    space between the amniotic membrane and the embryo
  129. amniotic cavity encircles
    the amnion, embryo and yolk sac
  130. function of amniotic fluid
    • cushion to protect against injury controls temperature, permits
    • external symmetric growth, prevents adherence to amnion, allows freedom
    • of movement, aids in musculoskeletal development, acts as a source of
    • oral fluid as well as a waste repository and assists in lung development
  131. how is amniotic fluid formed?
    initially by diffusion from maternal blood; fetus urinates into fluid, greatly enhancing volume
  132. amniotic fluid increases from 30 mil @ 10 wks to
    1200 ml @ delivery
  133. amniotic fluid acidic or alkaline?
  134. fetus swallows how much amniotic fluid?
    600ml a day and 400ml a day flows out of lungs
  135. umbilical cord begins formation from
    amnion at day 14 and is called "connecting stalk or body stalk"
  136. umbilical cord attaches?
    the embryo to yolk sac, contains blood vessels and extends into chorionic villi
  137. fuses with embryonic portion of placenta and provides circulation from chorionic villi to embryo
    umbilical cord
  138. umbilical cord consist of
    one large vein and two smaller arteries
  139. wharton's jelly
    connective tissue that surrounds the blook vessels in the umbilical cord
  140. umbilical cord is how big?
    2cm (.8 inches) across and 55cm (22in) long
  141. placenta
    develops at the site where the embryo attaches to the uterine wall. thin disc shape temporary organ.
  142. function of placenta
    • early (endocrine gland) later 4th wk metabolic and nutrient exchange
    • between embryo and meteranl circulation, storage, and respiration
  143. placenta produces
    hCG, progesterone, estrogens, hPL
  144. placental function depends on
    maternal blood pressure
  145. 2 parts of placenta
    maternal (red and flesh like) and the fetal portion (shiny, gray appearance)
  146. methods of placental exchange
    diffusionfacilitated and active transport (substances with high molecular weight)pinocytosis (large molecules)
  147. Nagel's Rule
    begin with first day of last period, subtract 3 months and add 7 days (EDB/gestational wheel uses same premise) to calculate due date
  148. weight gain in pregnancy
    3-5 lbs in 1st trimester, then avg 1lbs per week
  149. noninvasive, nonexpensive. flase positives. FHR recorded with tocotrasducer. Strip is observed for FHR movements in correlation with accelerations in FHR.

    freq in high risk pts?
    NST - non stress test

    bi weekly
  150. reactive NST
    3 accelerationsin 15-20 minutes greater than 15x15, LTV>10bpm
  151. non reactive NST
    does not meet reactive criteria and must move to BPP or CST
  152. common discomforts of pregnancy during 1st trimester
    N/V, urinary frequency, fatigue, increased vaginal discharge, breast tenderness, nasal stuffiness and epitaxis, ptyalism
  153. common potential complications during 1st trimester
    severe vomitting (hyperemesis, gravidarum, chills, fever, dysuria, diarrhea, abdominal cramping and bleeding (miscarriage)
  154. common discomforts of pregnancy during 2nd and 3rd trimesters
    heartburn, edema, varicose veins, constipation/flatulence, hemorrhoids, backache, leg cramps, SOB, diff. sleeping, faintness, round ligament pain, carpal tunnel syndrome
  155. common potential complications during 2nd and 3rd trimester
    hyperemesis, HTN, PIH, PROM, miscarriage, previa, abruptio placenta, infection, kidney stones or infection, preterm labor, and gestational diabetes
  156. self care measures for N/V
    avoid odors or causative factors; eat dry cracker or toast before arising in the morning; have small but frequent meals, avoid greasy or highly seasoned food; take dry meals with fluids between meals; drink carbonated beverages
  157. self care for urinary frequency
    void when urge is felt; increase fluid intake during the day; decrease fluid intake ONLY in the evening to decrease nocturia
  158. self care for fatigue
    plan time for a nap or rest period daily, go to bed earlier, seek family support and assistance with responsiblities so that more time is available to rest
  159. self care for breast tenderness
    wear well fitting supportive bra
  160. self care for increased vaginal discharge
    promote cleanliness by daily bathing, avoid douching, nylon underwear, and pantyhose; cotton underwear are more absorbent; powder can be used to maintain dryness if not allowed to cake
  161. self care for nasal stuffiness/epitaxis
    may be unresponsive but cool air vaporizor may help; avoid use of nasal spray and decongestants
  162. self care for ptyalism
    use astringient mouthwashes, chew gum or suck on hard candy
  163. self care for heartburn
    eat small and more frequent meals, use low sodium antacids, avoid over eating, fatty and fried foods, lying down after eatingand sodium bicarb
  164. self care for ankle edema
    practice frequent dorsiflexion of feet when prolonged sitting or standing is necessary, elevate legs when sitting or resting, aviod thight garters or restrictive pants or bands around legs
  165. self care for varicose veins
    elevate legs frequently, wear supportive hose, avoid crossing legs at the knees, standing for long periods, garters, and hosiery with constrictive bands
  166. self care for hemeorrhoids
    avoid constipation, apply ice packs, topical oitments, anesthetic agents, warm soaks, or sitz baths; gently reinsert into rectum as necessary
  167. self care for constipation
    increase fluid intake, increase fiber in diet, exercise; develop regular bowel habits, use stool softeners as recommended by MD
  168. slef care for backache
    use proper body mechanics, practive the pelvic tilt exercise, avoid uncomfortable working heights, high-heeled shoes, lifting heavy loads and fatigue
  169. self care for leg cramps
    practice dorsiflexion of feet to stretch affected muscle; evaluate diet; apply heat to affected muscles; arise slowly from resting position
  170. self care for faintness
    avoid prolonged standing in warm or stuffy environments; evaluate H&H
  171. self care for dyspnea (SOB)
    use proper posture when sitting and standing; sleep propped up with pillows for relief if problem occurs at night
  172. self care for flatulence
    avoid gas-forming foods; chew food thoroughly; get regular daily exercise; maintain normal bowel habits
  173. self care for carpal tunnel syndrome
    avoid aggravating hand movements; use splint as prescribed; elevate affected arm
  174. recessive autosomal disorder in which adult hemoglobin is abnormally formed causes RBC's to sickle; found primarily in AA
    Sickle Cell Anemia
  175. risks associated with sickle cell anemia
    nephritis, heaturia, anemia, crisis, fetal death, prematurity, IUGR
  176. represent an assessment of the five fetal biophysical variables
    BPP (biophysical profile)
  177. Five fetal biophysical variables
    • 1. FHR acceleration
    • 2. fetal breathing
    • 3. fetal movements
    • 4. fetal tone
    • 5. amniotic fluid volume
  178. how is BPP assessed
    FHR acceleration
    all others

  179. purpose of BPP
    identify compromised fetus and confirm healthy fetus
  180. BPP most useful in?
    decreased fetal movememnt, mgt of intrauterine groth restriction, preterm labor, gestational diabetes, postterm pregnancies, and premature rupture of the membranes (PROM)
  181. two most important components of BPP
    • NST - reflects the intactness of the nervous system
    • amniotic fluid index (AFI) - reflectes kidney perfusion
  182. BPP test interpretation 0-10/10 (by 2's)
    • 10/10 - normal
    • 8/10 (normal fluid) - risk of fetal asphyxia extremely rare
    • 8/8 if no NST done
    • 8/10 (abnormal fluid) - chronic fetal asphyxia suspected
    • 6/10 - possible fetal asphyxia
    • 4/10 - probable fetal asphyxia
    • 2/10 - almost certain fetal asphyxia
    • 0/10 - certain fetal asphyxia
  183. detection and Dx of gestational diabetes
    • Urine testing - sugar and ketones
    • 50 g oral glucose tolerance test (1hr)
    • if 1 hr abnormal then do 3 hr 100g oral glucose tolerance test (OGTT)
    • will need to eat high CHO diet for 3 days, then fasting for 8 hrs; glucose is tested at fasting 1, 2, 3 hrs
  184. Dx of GD
    if 2 or more glucose values exceed:
    • fasting >105
    • 1 hr >190
    • 2 hr > 165
    • 3 hr > 145
  185. gravida
    any pregnancy, regardless of duration including present pregnancy
  186. para
    birth after 20 weeks' gestation regardless of whether the infant is born alive or dead
  187. GTPAL
    • G - gravida
    • T - term (full -term 37-40 wks)
    • P - preterm (infants born >20wks but <37 wks)
    • A - abortions (pregnancies ending in spontaneous/therapeutic abortion)
    • L - living
  188. high risk screening should be done on who?
  189. EXPECTED outcome with Mg sulfate

    SIDE EFFECT with Mg sulfate
    Seizure prevention

    • decrease in BP
    • decrease in contractions
  190. risk factors for PIH (preeclampsia)
    • 1st pregnancy
    • non-caucasian
    • age <18, >35
    • lower socioeconomic status
    • hydatiform mole (GTD), diabetes
    • multiple gestation, Rh incompatibility
    • Family Hx (mother, sister) of PIH
  191. S&S of PIH
    HA, blurred vision, protenuria
  192. pathophisiology of PIH
    cause is unknown; increased senstivity to pressors; vasospasm and early hemodynamic alteration are responsible for S&S; prostacyclin (vasodilator) decrerased in pregnancy; thromboxane (produced by platelets) causes vasoconstriction and clumping of platelets; impaired placental profusion; reduced kidney profusion; decreased liver profusion; vasospasm and decreased blood flow to retina - visual disturbances; vasospasm in brain - cerebral edema, CNS irritability, hyperreflexia, HA, seizures, LOC and affect changes; coagulation abnormalities; decreased albumin, fluid shifts edema
  193. Dx of PIH
    • Mild - increase of systolic BP >30, increase of diastolic >15 or baseline BP of > 140/90 readings on 2 occasions 6hrs apart
    • Severe - BP of >160/110 on 2 occasions 6 hrs apart
    • Eclampsia - convulsion or coma
  194. manifestations in Mild PIH
    Protenuria 1-2+ (<5g/2H); edema, dependent, some face and hands; absent - transient HA no visual dist.; urninary output >30mL/hr; Labs, normal platelets, creatinine, liver enzymes; fetal growht WNL, no placental aging
  195. manifestations in severe PIH
    protenuria > 3+(>5G/24H); edema, generalized, pulmonary edema; HA, > 3+ DTRs, clonus, visual distrub, epigastric pain, irritability; urinary output <30mL/hr; labs - thrombocytopenia, >creatinine, liver enzymes and HCT; fetal growth restriction and placental aging
  196. S&S of worsening PIH
    increasing edema; HA, disorientation; visual disturbances; hyperreflexia, clonus; decreasing urniary output; N&V disorientation, epigastric pain; bleeding gums c/o not feeling well
  197. HELLP syndrome
    • H - hemolysis
    • EL - elevated liver enzymes
    • LP - low platelets
  198. S&S of HELLP
    N&V, malaise, epigastric pain, flu-like sx,; assoc with severe pre-elalampsia, but may develop before onset of PIH sx; occurs prior to 36 weeks in 90% of cases
  199. eclampsia
    occurance of seizure or coma; likely related to vasospasm, edema, hemorrhage, ischemia, HTN or metabolic encephalopathy
  200. S&S of eclampsia
    dark spots or flashing lights; epigastric pain, vomitting, severe HA; pulmonary edema, cyanosis, neuro hyperactivity
  201. nursing management for eclampsia
    • asses seizure - OLDCARTS
    • status of fetus - signs of abruption
    • maintain airway give O2
    • position on side to avoid aspiration
    • SR up and padded
    • give MgSO4 as bolus ordered
    • admin her meds as ordered
  202. tx of mild PIH
    • activity restrict
    • high protein diet
    • fetal surveillance
    • teach of worsening S&S
    • monitor well being
  203. tx of severe PIH
    • complete bed rest (hospitalization);
    • diet - high protein, mod Na
    • anticonvulants - MgSO4
    • corticosteroids
    • F&E replace
    • sedatives
    • anti HTN
  204. positions for self breast exam
    both arms relaxed; both arms above head; both hands on hips while leaning forward