NCM 105

Instructor: Mrs. Glady’s Reina M. Maitem

INFECTIONS - Loss of protective Dx – vaginal or urine culture
lactobacilli bacteria (aka DDH notifies partners
A. URINARY TRACT vaginitis) Rx with Rocephin IM
INFECTIONS - Thin, watery vaginal (ceftriaxone), Zithromax
delivery with clue cells seen (azithromycin) 1 g single dose
- Caused by: E. coli, under microscope vaginal for amoxicillin PO
Klebsiella, Proteus pH >5
- S/S: Asymptomatic Tx: with flagus (metronidazole PID (Pelvic Inflammatory
Bacteriuria = (+) bacteria in 500 mg BID x 7 days) avoid Disease)
urine intake of alcohol similar to
- Example: no symptoms Antabuse – severe - Cramping, fever, chills,
Rx: Early pregnancy, oral - Risk factor for PROM purulent discharge, N/V
sulfonamides Bactrim uterine swelling adnexal and
- Late: Ampicillin, furoclantin TRICHOMONIASIS cervical tenderness
- If left untreated, infection (“strawberry” cervix) - Multiple sex partners no
led to acute, pyelonephritis - Different organism caused condoms
by parasite trichomonas Tx with doxycycline i.o
B. CYSTITIS (Lower UTI) vaginalis. Vaginal discharge (contraindicated in pregnancy)
(thin, greenish, yellow and Rocephin IM
S/S: Dysuria, urgency, discharge or foamy) clindamycin/gentamycin/Rocep
frequency, low grade fever, - An STI hin if pregnant may need
clean catch leukocytes >10,000 Same Tx as BV for PTL and hospitalization
counts PROM
- Same as UTI, occurs in HERPES (Herpes Genetalis)
bladder F. STIs
- Viral infection – no cure
C. ACUTE (Chlamydia) - HSV 1 – oral (cold, sore)
PYELONEPHRITIS outer lesion
- Caused by: bacterium - HSV 2 – genital painful,
- Infection of kidney, caused chlamydia trachomatous open lesion
by same microorganisms - Most common STI in USA - Vesicles rupture and appear
S/S: Chills, fever, flank pain, - Often asymptomatic: tight after exposure or
dysuria, low urine thin/virulent discharge within 20 days
burning and frequency with - Burning sensation with
D. MONILIAL VAGINAL urination lower and pain urination is 1st sign
INFECTION - Pregnant women: Zithromax - Prodrome “tingling” occurs
1 g single dose amoxicillin x before new outbreak
- Caused by: 80% candid 7 days Dx: vaginal seen or blood test
ablicans – caused by change Rx: acyclovir or Valtrex 500 mg
in normal vaginal pH – pH NEWBORN once a day during pregnancy
<5 – acidic CONJUNCTIVITIS reduces viral load enough to
S/S: thick white discharge (erythromycin ointment) deliver vaginally
severe itching dysuria. Wet neonatal pneumonia, PTL, fetal
mount hyphae, budding yeast death, Perinatal transmission SYPHILIS: Treponema
Risk factors: occurs in 50% infants where Palladium (Spirochete)
- HIV, DM, pregnancy mom is infected at time of
Tx: Intravaginal micronamole delivery - Primary stage: painless
suppository at hours of sleep for sores “chancre”,
1week GONORRHEA (Endocrine approximately 2-3 weeks
- Implication: fetus may Gonorrhea) after initial exposure, fever,
contact thrush during malaise
delivery - Caused by: Neisseria - Secondary stage: 6 weeks to
- Infant with oral nystatin 1 cc Gonorrhea, Bacteria STI 6 months, skin eruptions,
< every 6 hours - Can lead to PID > infertility arthritis, liver enlarged, sore
- Teach: no douching; cotton green frothy discharge throat
underwear - Often asymptomatic in Tx:
females, males have burning - < 1 year 2.4 million
E. BACTERIAL VAGINITIS with urination and penile benzathine penicillin x 1
- Overgrowth of gardenella damage dose IM
(normal vaginal flora
NCM 105
Instructor: Mrs. Glady’s Reina M. Maitem
- > 1-year same medication 1 - Denial – guilt, fear of legal TOBACCO
x per week x 3 weeks consequences, loss of - Impaired O2 delivery
- Sexual partners screened for custody of children nicotine-induced
treatment - History taking, maternal vasospasm, carbon
- If allergic to penicillin tx testing after informed monoxide, other chemicals,
ceftriaxone > 1 trimester
st
consent, etc. chromosomal instability
- 40% chance of still birth or - Be sensitive and respectful lung development
death > birth – infant may in interviewing - Preterm delivery, low birth
be born with “congenital - Ask about frequency, time weight (<2,500 g), small for
syphilis” of last use, route gestational age, PPROM,
- Ophthalmia neonatorum: administration placenta previa, abruption,
can cause blindness appears Risk factors: IUFD
as conjunctivitis in newborn o Late prenatal care - SIDS, asthma, otitis media
o Missed prenatal visit - Idiopathic mental
GENITAL WARTS – virus - DOBHx: miscarriage, retardation, ADHD
(aka Condyloma) IUGR, premature birth - Pharmacotheraphy to those
- Child with unlikely to quit
- Soft pink lessions on vulva, neurodevelopmental
vagina, cervix, anus problems B. MARIJUANA
“cauliflower appearance” - Child not living with mother - Most common illicit
- HPM, type 6 and 1 cause History of drug substance used in pregnancy
90% of genital warts - Detectable in urine for
- 120 strains HCV Management: weeks
Tx: Trichloroacetic acid-aldara - Counselling - Adverse effects
Category C - Social learners inconclusive: association
- Benefits (pregnancy) maybe - Testing for stos with sleep disturbance
acceptable over potential - Frequent prenatal visits, - Small fetal head circulation
risk education - Decreased intelligence,
- Contacts occur during - Early ultrasound autinomic loss stability
vaginal birth. Infant may - Antepartum fetal - Betablockers
have laryngeal warts surveillance contraindicated
- Conforming pediatrics of - Leukemia,
Gardasil Vaccine: 3 doses possible neonatal phadomyosarcoma
- HPV Types 16 and 18 – withdrawal
(80% cervical cancer) and C. COCCAINE
types 6 and 11 (90% genital A. ALCOHOL - Crosses the placenta and
warts) - No level is safe fetal blood-brain barrier
- Can be given to males - Spontaneous abortions, - Vasoconstriction
stillbirth due to fetoplacental hypertension
deflection small for - Crack babies – tremors, high
Substance Abuse gestational age – pitched cry, irritability,
 4% of pregnant we elicit - ADHD, oppositional defiant excessive suck,
substances disorder conduct disorder hyperalertness, autonomic
 Half of substance - Binge drinking disorder in stability
abusing women continue adult offspring - Betablockers
using during pregnancy - Future drinking problem contraindicated
 An even larger - Associated with delayed
proportion Abule FETAL ALCOHOL cognitive, language
tobacco or alcohol SYNDROME development
 Pregnant women DISORDER (FASD)
typically lightly - Diagnostic criteria requires D. HEROINE
motivated to modify all times - Pre-eclampsia, third
behavior to help their - Growth problems trimester bleeding
unborn child - Facial dysmorphia - Neonatal abstinence
- Thin vermilion syndrome
Screening - Short palpebral fissures - Increased autonomic
- Substance abusers come - CNS abnormalities reactivity with withdrawal
from all socioeconomic symptoms begin 24 hours
statuses, ages and races after birth, 40 hours with
NCM 105
Instructor: Mrs. Glady’s Reina M. Maitem
methadone or organ damage d/t systemic If the two types of blood
buprenorphine vasoconstriction mix, the body will make
- Premature – reduced risk - Headache: visual changes; antibodies
- Supportive therapy confusion, abdominal pain; S/S: severe anemia, liver
- Methadone treatment impaired liver function with dysfunction, kidneys, severe
- Bulimorphine hyperbilirubinemia; baby jaundice (management for
oliguria; proteinuria; jaundice = phototherapy)
Nursing Considerations: pulmonary edema;
hemolytic anemia; RHOGAM
 Ask – at each visit thrombocytopenia; fetal - 28 weeks
 Advise – cessation growth retardation - 10 prevent from producing
 Assess – willingness - Eclampsia (seizures) may antibodies
 Assist – establish a plan follow - 11 prevent mother from
 Arrange – follow, being sensitize
referrals, support Nursing Intervention: for a
woman w/ mild PIH: GESTATIONAL DIABETES
 Clients with mild pre- AKA “GDM”
PRE-ECLAMPSIA eclampsia can be - Glucose intolerance
- BP > 140/90 managed at home with beginning in pregnancy’
- Presents with hypertension, fragment following care - GDM occurs 20th with no
proteinuria, edema of face,  Monitor antiplatelet incidence of anomalies
hands ankles therapy - 2% have undiagnosed type
- Occur anytime > 20th weeks  Promote bed rest II entering pregnancy
of pregnancy  Promote good nutrition - Type 1&2 have anomalies
- Usually occurs closer to due  Provide emotional d/t organogenesis (1st
date, will not resolve until support monitor FHR trimester)
after birth can progress to  Deliver close to EDC - 4% of pregnant affected
help syndrome - Maternal Risk: HTN
 Monitor BP
- Dip stick – to know if there disorders, polyhydramnios,
is protein in urine macrosomia (c/s rate)
BP: 160/90 – give magnesium
o Diagnostic: to know - Infant risks: Birth trauma,
sulfate IM @ buttocks
if there is protein in shoulder dystocia,
Antidote: calcium gluconate
urine (+) hypoglycemia,
- AC should be full blast
o 24-hour urine hyperbilirubinemia, fetal
- Turn on electric fan
death
collection - Icepacks
o Greater than 5 grams
Risk factors:
is considered Drugs for Pre-eclampsia
M – maternal age over 25 years
proteinuria 1. Magnesium Sulfate –
old
muscle relaxant;
O – overweigh >25 /obesity
GENERAL SIGN OF PRE- prevents seizure
>30
ECLAMPSIA (loading dose (4-6g
M – Macrosomia (large babies)
- Rapid weight gain; swelling maintenance dose
> 9 lbs
of arms/face 1-2g/hIV)
M – multiple pregnancy
- Headache; vison changes 2. Hydralazine –
A – a history of previous of
(blurred vision, feeling antihypertensive (5-
GDA family Hx GDM
double, seeing spots) 10mg/IV) administer
- Dizziness /faintness/ ringing slowly to avoid sudden
Screening & Diagnosis of
of ears/confusion; seizures fall in blood pressure.
GDM
- Abdominal pain, decrease 3. Diazepam (Valium) –
- Screen all women @ 24-28
production of urine: nausea, halt seizures (5-10
weeks
vomiting blood or blood in mg/IV)
- Higher risks patients
urine 4. Calcium gluconate –
screened in 1 semester/ 1st
st
antidote for magnesium
prenatal visit and @ 24-28
Mild: intoxication (1g/IV – 10
weeks
- mild HTN, no end-organ ml of a 10% solution)
damage; minimal
1st do:
proteinuria RH SENSATION
- 1 hour glucose challenge
Severe: - You may have Rh-negative
test (GCT) – 50g oral
- Significant HTN, severe blood and your baby may
glucola no fasting needed
proteinuria (>50 g/d); end you have Rh-positive blood.
NCM 105
Instructor: Mrs. Glady’s Reina M. Maitem
- Recommended GCT value - Teach monitoring of fasting
<140 mg/dl (detects 80%) and post prandial levels
- Follow GCT >/ = 140 mg/dl
with diagnostic 8 hours. If diet can’t control glucose,
GTT (glucose tolerance start insulin
test) 100g. glucona - Regular and intermediate
- Do fasting 1hr, 2hr, 3h acting insulin for breakfast
serum. Fast at least 8 hours and dinner
with at least 150g carb - Does not cross placenta
intake 3 days prior to test & - Dose base in weight &
normal activity level gestational age
- Chose patients with
GTT diagnostic Thresholds: increased dose

Fasting blood sugar: 95 mg/dl Intrapartum: monitor glucose

Drink 100g glucola levels every 2 hours (insulin
given @ 100 mg per dl <
1 hour: 180 mg/dl plasma level
2 hours: 155 mg/dl Postpartum: most return to
3 hours: 140 mg/dl normal after delivery
- Diagnosis of GDM if 2 or - 50 % patients with GDM
more values than above develop type II later in life
plasma levels - 6-weeks pp serum glucose
- Children of GDM patients
Management: increase for obesity in
- May try standard diabetic childhood adolescence.
diet 1st depending on lab
values
- Initiate insulin for fasting
>95 and 2 hours
postprandial
- 120 mg/dL

Intervention: Antepartum

Goal: Strict glucose control

- Provide immediate
education to patient or
family
- Standard diabetic diet
(2000-2500 cal/day)

Distribution of calories: 40-

50% carbs, 20% protein, 30-
40% fat (<1/3 from saturated
fat, 1/3 polyunsaturated, rest
monosaturated)

Recommended: 3 meals and 3

snacks evenly spaced to avoid
swings in blood glucose. Snack
at bedtime 1,200 mg/day
calcium, 30 mg/day iron, 400
mcg/day folate

- Exercise (walking,
swimming) 30 minutes, 3.4
x per week
- Teach daily glucose self-
monitoring and urine testing