Gestational Hypertension
- New-Onset Hypertension
- > 20 Weeks Gestation
- Nulliparity
- Obesity
- African American Females
- > 35 years Old
- Multiple Gestations
- Family History of Gestational HTN (or Preeclampsia)
- IUGR
- Prematurity
- Abruptio Placentae
- Fetal Monitoring
- Alpha-Methyldopa
- Beta-Blockers (Labetalol)
- Calcium Channel Blockers
- Hydralazine
Preeclampsia Assessment
- After 20 Weeks of Pregnancy
- Hypertension > 140/90
- Proteinuria or End-Organ Dysfunction
- Hypertension > 160/110
- Progressive Renal Insufficiency
- Vision Changes
- HELLP Syndrome
- Pulmonary Edema
Preeclampsia Interventions
- Side Lying Position and Bedrest
- Antihypertensives
- Magnesium Sulfate
- Labor Induction
Severe Preeclampsia
- Vasospasm and Decreased Organ Perfusion
- Intravascular Coagulation
- Increased Permeability and Capillary Leakage
- Hypertension
- Proteinuria or End-Organ Dysfunction
- Hepatic Dysfunction and Hemolysis
- Elevated Liver Enzymes
- Low Platelet Counts
Abruptio Placentae
- Premature Separation of Placenta
- Tearing Pain
- Bleeding (Often Concealed)
- Rigid Uterus
- Contractions
- Corticosteroids as Needed
- Emergent Delivery
- Increased Risks for Neonate
- Rh (Rhesus) Incompatibilities
- Increased Risk for Shock
- Monitor Fetal Heart Rate
Placenta Previa
- Placenta Covers Cervical Os
- Painless
- Bright Red Vaginal Bleeding
- Stable Fetus
- Bed Rest
- Observation
- Unstable Fetus
- C-section Delivery
- Risk for Shock
- Magnesium Sulfate
- Tocolysis
Level of Consciousness: Descriptive guide for Glasgow Coma Scale
- Conscious
- Confused
- Delirious
- Somnolent
- Obtunded
- Stuporous
- Comatose
Postpartum Nursing Assessment
- BUBBLE - LE
- Breasts
- Uterus
- Bladder
- Bowels
- Lochia
- Episiotomy (Laceration)
- Lower Extremities
- Emotions
Hydralazine (Apresoline)
- Severe Hypertension
- CHF
- Reduced Afterload
- Pregnancy
- Vasodilates Arterioles
- Drug-induced Lupus
- Reflex Tachycardia
- Hypotension
- Combined with Diuretic and Beta Blocker
Magnesium Sulfate
- Muscle Relaxant
- Preterm Labor Contractions
- Preeclampsia
- Warm Feeling
- Hypotension
- Decreased Deep Tendon Reflexes (DTRS)
- Decreased Respiratory Rate
- Decreased Urine Output
- Paralytic Ileus
- Calcium Gluconate
Hypermagnesemia
- Flushing
- Lethargy
- Muscle Weakness
- Decreased Deep Tendon Reflexes (DTRs)
- Decreased Respirations
- Bradycardia
- Hypotension
- Dialysis
- IV Calcium Gluconate
- Diuretics
- Avoid Antacids and Laxatives containing Mg2+
Calcium Channel Blockers (Verapamil and Diltiazem)
- Slows AV Conduction
- Angina Pectoris
- Arrhythmias
- Essential Hypertension
- Bradycardia
- Hypotension
- Constipation
- Peripheral Edema
- Gingival Hyperplasia
- Medication Education
Hemoglobin
- Hemoglobin Has Four Iron Hemes
- Lots Of Hemoglobin In Red Blood Cells
- High O2 Levels Increase O2 Binding
- High Temperature Reduces O2 Binding
- High CO2 Levels Reduce O2 Binding
- Low pH Reduces O2 Binding
- Myoglobin Binds Oxygen in Muscle
Hematocrit (Hct) Lab Values
- Women: 36% - 46%
- Men: 41% - 53%
PT/PTT Lab Values
- Prothrombin Time (PT)
- 10-14 seconds
- Activated Partial Thromboplastin Time (PTT or aPTT)
- 25-35 seconds
BUN (Blood Urea Nitrogen) Lab Values
Creatinine Lab Values
- Measures Renal Function
- 0.6 - 1.3 mg/dL
Liver Enzyme Tests: AST and ALT
- AST/ALT Ratio
- AST: 8-20 U/L
- ALT: 8-20 U/L
Bilirubin Lab Value
- 0.2-1.2 mg/dL
- Increased Bilirubin Causes Jaundice
Seizure Precautions
- Reduce Environmental Stimuli
- Identify Triggers
- Aura
- Pad Side Rails
- Bed Lowest Position
- Oxygen and Suction Available
- Monitor Therapeutic Drug Levels
Seizure Interventions
- Maintain Airway
- Side-lying Position
- Support Head
- Move to Floor
- Benzodiazepines
- Never Restrain
- No Objects in Mouth
- Document Details
Eclampsia
- Increased Central Nervous System Irritability
- Hyperreflexia
- Positive Ankle Clonus
- Headaches
- Visual Disturbances
- Epigastric or RUQ Pain
- Seizures
- Coma
- Don't Leave Bedside
- Magnesium Sulfate
Diabetes Assessment
- Juvenile Onset
- Absent Insulin Production
- Ketosis Prone
- Adult Onset
- Insulin Resistance
- Obesity
- Onset During Pregnancy
- Glucose Intolerance
- Retinopathy
- Peripheral Vascular Disease
- Nephropathy
- Neuropathy
Diabetes Interventions
- Early Diagnosis
- Insulin
- Oral Hypoglycemics
- Glucose Monitoring
- Routine Exercise
- Diabetic Diet
- Monitor for Complications
- Insulin Therapy
- Diabetic Ketoacidosis (DKA)
Hypoglycemia Assessment
- Too much insulin
- Decreased glucose
- < 70 mg/dL
- Change in LOC
- Lethargic
- Confusion and Irritability
- Tremors
- Diaphoresis
- Tachycardia
- Vision Changes
- Weakness
- Seizures
Hyperglycemia
- Insulin Resistance
- Too Little Insulin/Medication
- Infection/Illness
- Corticosteroids
- Elevated Blood Glucose
- Polyphagia
- Polydipsia
- Polyuria
- Hypotension
- Fatigue/Drowsiness
Oral Glucose Tolerance Test (OGTT)
- Used for Diabetes Screening
- Fasting State
- Baseline
- Normal < 100 mg/dL
- 30 and 60 Minutes
- Normal < 200 mg/dL
- 120 Minutes
- Normal < 140 mg/dL
Insulin
- Rapid Acting
- Insulin Lispro (Humalog)
- Insulin Aspart (Novolog)
- Insulin Glulisine (Apidra)
- Short Acting
- Regular Insulin (Humulin R)
- Intermediate Acting
- Isophane NPH (Humulin N)
- Long Acting
- Detemir (Levemir)
- Glargine (Lantus)
Postpartum Hemorrhage
- Uterine Atony
- Lacerations
- Retained Placenta
- Bleeding
- Hypotension
- Boggy Uterus
- Oxytocin
- Bimanual Compression of Uterus
- Surgery
- Blood Transfusion
Postpartum Infection
- Fever > 100.4F After 24 Hours (38 C)
- Multiple Vaginal Examinations
- Vaginal Trauma
- Prolonged Rupture of Membranes
- Cesarean Birth
- Anemia of Pregnancy
- Retained Placental Fragments
- Poor Health Status
Breastfeeding
- Complete Nutrition
- Antibody Protection
- Bonding
- Convenient
- SIDS Risk Reduced
- Possible Enhanced Cognitive Development
- Long-Term Health Benefits
Iron Deficiency Anemia
- Malnutrition/Malabsorption
- Hemorrhage
- Microcytic, Hypochromic Anemia
- Decreased Heme Synthesis
- Decreased Reticulocytes
- Decreased Ferritin
- Increased Red Cell Distribution Width (RDW)
- Poikilocytosis
- Anisocytosis
- Increased Central Pallor
Iron (Ferrous Sulfate)
- Ferrous Salts
- Anemia
- GI Distress
- Nausea and Vomiting
- Dark Stools
- Take Between Meals
- Liquid can Stain Teeth
- Keep out of Reach from Children
- Caution with GI Disorders
- Avoid Antacids
Hemoglobin (Hgb) Lab Values
- Men: 13 - 17 g/dL
- Women: 12 - 16 g/dL
TORCHeS Screening
- Toxoplasmosis
- Other
- Rubella
- Cytomegalovirus (CMV)
- Herpes Simplex Virus (HSV)
- Syphilis
- Diagnostic Testing
Chlamydia
- Chlamydia trachomatis
- May Be Asymptomatic
- Dysuria
- Epididymitis
- Discharge
- Dyspareunia
- Doxycycline
- Azithromycin
- No Intercourse for 1 Week
- Treat Partners
Gonorrhea
- Neisseria gonorrhoeae
- Dysuria
- Yellowish-Green Discharge
- Increased Urinary Frequency
- Women Often Asymptomatic
- Ceftriaxone (IM)
- Doxycycline
- Azithromycin
- Treat Partners
Streptococcus agalactiae
- Group B Streptococci
- Gram-Positive
- Cocci
- Beta-Hemolytic
- Bacitracin-Resistant
- Catalase-Negative
- Pyrrolidonyl Arylamidase (PYR) Negative
- Polysaccharide Capsule
- Hippurate Positive (+)
- Produces CAMP Factor
- Enlarges Area of Hemolysis by S. aureus
- Mainly in Babies
- Meningitis
- Pneumonia
- Sepsis
- Colonizes Vagina
- Screen Pregnant Women at 35-37 Weeks
- Penicillin
Herpes Simplex Virus (HSV)
- Enveloped
- Double Stranded DNA
- Linear
- Type 1 HSV
- Gingivostomatitis
- Keratoconjunctivitis
- Encephalitis of Temporal Lobes
- Latent in Trigeminal Ganglia
- Type 2 HSV
- Genital Vesicles
- Neonatal Herpes
- TORCHES
- Latent in Sacral Ganglia
- Tzanck Test
- Multinucleated Giant Cells
- Cowdry A Inclusions
- Acyclovir
Human Papillomavirus (HPV)
- Non-enveloped
- Circular
- Double Stranded DNA
- Warts 1, 2, 6, 11
- Condyloma acuminata
- Type 16, 18
- Cervical Carcinoma
- Penile Carcinoma
- AIDS/Immunocompromised
- Worsened by Smoking
- Koilocytic change in squamous epithelium
- Pyknotic Nuclei Surrounded by Clear Halo
- Vaccine Available
Syphilis TORCH
- Nonspecific TORCH Symptoms
- Often Results in Stillbirth
- Hydrops Fetalis
- Saber Shins
- Notched Teeth
- Saddle Nose
- Blindness
- Deafness
- Hepatitis
Trichomonas vaginalis
- Protozoa
- Vaginitis
- Pruritus
- Foul-smelling Greenish Frothy Discharge
- Strawberry Cervix
- Corkscrew Motility on Wet Prep
- Metronidazole
Toxoplasma gondii TORCH
- Congenital TORCH Infection
- Mom Usually Asymptomatic
- Rarely Lymphadenopathy
- Nonspecific TORCH Signs
- Intrauterine Growth Retardation
- Hepatosplenomegaly
- Deafness
- Chorioretinitis
- Hydrocephalus
- Calcifications
Hepatitis A
- Picornavirus
- 4 Week Incubation Period
- Fecal-oral
- Day Care Centers
- Travel to Developing Countries
- Usually Asymptomatic
- Acute Disease
- Jaundice
- Fever
- Vomiting
Hepatitis B (HBV) Assessment
- Bodily Fluids
- Blood Transmission
- People Who Use IV Drugs
- Variable 1-6 Months
- Fever
- Nausea and Vomiting
- Hepatomegaly
- Cirrhosis
- Hepatocellular Carcinoma
- Vaccination
Rubella TORCH
- Nonspecific TORCH Symptoms
- Patent Ductus Arteriosus
- Pulmonary Artery Hypoplasia
- Cataracts
- Deafness
- Blueberry Muffin Rash
- Glaucoma
Cytomegalovirus (CMV) TORCH
- Nonspecific TORCH symptoms
- Intrauterine Growth Restriction (Retardation)
- Deafness
- Microcephaly
- Seizures
- Periventricular Calcifications
- Petechial Rash
- Blueberry Muffin Rash
- Chorioretinitis
- Urine Viral Culture or PCR
Human Immunodeficiency Virus (HIV) Assessment
- RNA Retrovirus
- CD4+ Helper T Cells
- Flu-like Symptoms
- Lymphadenopathy
- Fatigue
- Diarrhea
- Unexplained Weight Loss
- White Spots on Tongue
- Persistent Fever
- Night Sweats
Human Immunodeficiency Virus (HIV) Stages
- Primary Infection
- Within 3 Weeks
- Flu-like Symptoms
- Asymptomatic Stage
- Years
- Symptomatic Stage
- CD4+ < 500
- AIDS
- Opportunistic Infections
- CD4+ < 200
Gardnerella vaginalis
- Bacterial Vaginosis
- Not an STD
- Fishy Smell
- Whiff Test
- Grey Vaginal Discharge
- Increase pH
- Clue Cells
- Squamous Epithelial Cells Covered with Bacteria
- Mobiluncus Coinfection
- Metronidazole
Candida Albicans
- Fungi
- Yeast with Pseudohyphae at 20 Degrees C
- Germ Tube Formation at 37 Degrees C
- Pruritic Vaginitis
- White Cottage Cheese Discharge
- Fiery Red Mucosa
- Diabetics
- Antibiotic Use
- Esophageal Thrush in Immunocompromised
- Diaper Rash
- Endocarditis in IV Drug Users
Substance Use Disorder
- 2 or More Symptoms For 1 year
- Tolerance
- Withdrawal Symptoms
- Cravings
- Using More Than Intended
- Inability to Cut Down
- Time-Consuming Substance Acquisition
- Impaired Functioning at Work
- Reduced Recreational Activities
- Dangerous Activities
- Continued Use
Mechanism of Labor
- Engagement
- Descent
- Flexion
- Internal Rotation
- Extension
- External Rotation (Restitution)
- Expulsion of Infant
Induction of Labor
- Premature Rupture of Membranes
- Danger to Fetus or Mother
- Prolonged Gestation
- Placenta Abnormalities
- Transverse Fetal Position
- Prolapsed Umbilical Cord
- Active Genital Herpes Infection
- Transfundal Uterine Incision
- Hemorrhage
True vs. False Labor
- Bloody Show
- Regular, Strong Contractions
- Progressive Effacement and Dilation
- Engagement of Presenting Part
- Irregular Contractions
- Cervix Soft
- No Engagement of Presenting Part
Triage
- Simple Triage And Rapid Treatment (START)
- Red: Immediate (Critical)
- Yellow: Delayed (Urgent)
- Green: Minor (Ambulatory)
- Black: Deceased (Expired)
- Ability to Walk
- Spontaneous Breathing
- Respiratory Rate
- Check Circulation
- Mental Status
Prolapsed Umbilical Cord
- Cord Prolapses
- Visualization of Cord
- Prolonged or Variable Decelerations
- Hips Elevated
- Insert 2 fingers in Vagina
- Saline Towel on Cord
- Oxygen