NSG 123 exam 3
• N Meningitis
o Mother
Genital tract most serious
Colonization can cause chorioamnionitis, endometritis, postpartum
wound infection, UTI
GROUP BETA STREPTOCOCCUS (GBS) DIAGNOSTIC TESTS o Vaginal
Culture @ 35-37 weeks of pregnancy
o *On admission to unit…
is mother is GBS positive, negative or unknown o Is prophylaxis
needed?
Yes, if + or unknown
GROUP BETA STREPTOCOCCUS (GBS) o Treat if GBS+ or GBS unknown o
If not treated with antibiotics …baby can become positive…advise NICU
o Prevent early/late onset of disease
Antibiotics in labor
Determine membrane status ruptured or intact?
,If ruptured > 18 hours… higher risk
o Once positive during pregnancy, treat as positive for the rest of the pregnancy
Pharmacological treatment (GBS) o Mother
Antibiotics (at least 2 doses) 4 hours apart throughout labor (ampicillin
DOC)
If allergic to ampicillin
Choose another antibiotic
o Newborn
If inadequate prophylaxis of mother/newborn cultures
Close observation of newborn X48hours after delivery if
• Positive
• No prophylaxis
• If inadequate prophylaxis
Screening protocol
Complications of newborn o Early onset
Occurs during first week of life
Sepsis
Pneumonia
Meningitis o Late onset
Occurs first week -> 3 months
Meningitis (occurs more often here)
May have long term consequences
Developmental
Deafness
Other Hi risk complications of mother o Mother
Monitor for s/s of hi risk infection, temp and WBCs
• Chorioamnionitis
• Intrapartum fever
• Endometritis
• Post-partum wound infection
,
• UTI during pregnancy
• Sepsis protocol
• Triple antibiotics
• Screening/cultures of baby
Torch o T- Toxoplasmosis
Most exposed by the litter box
Parasitic infection
• Transferred from hand to mouth after touching cat feces…litter
boxes
• Gardening in contaminated soil
• Consuming undercooked meat
• Risk of passing infection to neonate (neurologic, IUGR, etc)
o O- Other (syphilis, hep B, cox sakie, Epstein- Barr, zoster) o R- Rubella
German measles…spread by droplet or direct contact
• Transmitted through placenta
• Education is key…screened on first prenatal visit with titer
• Immunize…MMR vaccine (live virus) not during a pregnancy
• Rubella titer of 1:8 acceptable to give immunity
o C- Cytomegalovirus – education is key
Leading cause of congenital infection
Prenatal screening not routinely performed
Greatest risk in first trimester
May have serious complications…hearing loss, intellectual, clinical
appearance, microcephaly
Many women during lifetime exposed & asymptomatic …may have titer
Acquire from sexual, kissing, blood transfusions, day care centers
Pregnant women…Hygiene guidelines-handwashing, diaper changes,
contact with urine, body secretions, pacifiers
Newest research-Send urine of newborn with failed hearing screen
,
Child Failing hearing screening is a red flag that they could of be
exposed in utero
o H-Herpes/HIV
Risk great during pregnancy/delivery
Zidovidine (ZDV) therapy pregnancy/labor if HIV positive
Breast feeding increases risk of transmission…advise against
With appropriate therapies, newborns usually do not become HIV positive o 5
categories
can cause a cluster of birth defects in newborn
• liver and spleen swelling
• encephalopathy
• microcephaly
• developmental issue
• intrauterine growth issues
o Blood test-titer
measures level of infant’s antibodies in response to specific agent
May indicate further testing (CSF or urine of NB)
STD’S/STI’S
o “Disease caused by microorganism transmitted through vaginal, anal, or oral
sexual intercourse” (CDC,2012) o Threat to sexual and general health
o Can become epidemic
o Millions live with an incurable STI o Sex with partners…who are partners? How
many partners?
o Complications more often in women than men
o Contribute to cancer, infertility, ectopic pregnancy, pain, death o Transmission
to fetus during pregnancy or delivery o Adolescents at greater risk…each year 4
million new cases(AMA, 2012)
o Elderly at increased risk
DIAGNOSTIC TESTING…STD/STI’S o Thorough history of present illness
o Risk factors present/past o Pelvic exam…genital lesions o Oral exam-
• N Meningitis
o Mother
Genital tract most serious
Colonization can cause chorioamnionitis, endometritis, postpartum
wound infection, UTI
GROUP BETA STREPTOCOCCUS (GBS) DIAGNOSTIC TESTS o Vaginal
Culture @ 35-37 weeks of pregnancy
o *On admission to unit…
is mother is GBS positive, negative or unknown o Is prophylaxis
needed?
Yes, if + or unknown
GROUP BETA STREPTOCOCCUS (GBS) o Treat if GBS+ or GBS unknown o
If not treated with antibiotics …baby can become positive…advise NICU
o Prevent early/late onset of disease
Antibiotics in labor
Determine membrane status ruptured or intact?
,If ruptured > 18 hours… higher risk
o Once positive during pregnancy, treat as positive for the rest of the pregnancy
Pharmacological treatment (GBS) o Mother
Antibiotics (at least 2 doses) 4 hours apart throughout labor (ampicillin
DOC)
If allergic to ampicillin
Choose another antibiotic
o Newborn
If inadequate prophylaxis of mother/newborn cultures
Close observation of newborn X48hours after delivery if
• Positive
• No prophylaxis
• If inadequate prophylaxis
Screening protocol
Complications of newborn o Early onset
Occurs during first week of life
Sepsis
Pneumonia
Meningitis o Late onset
Occurs first week -> 3 months
Meningitis (occurs more often here)
May have long term consequences
Developmental
Deafness
Other Hi risk complications of mother o Mother
Monitor for s/s of hi risk infection, temp and WBCs
• Chorioamnionitis
• Intrapartum fever
• Endometritis
• Post-partum wound infection
,
• UTI during pregnancy
• Sepsis protocol
• Triple antibiotics
• Screening/cultures of baby
Torch o T- Toxoplasmosis
Most exposed by the litter box
Parasitic infection
• Transferred from hand to mouth after touching cat feces…litter
boxes
• Gardening in contaminated soil
• Consuming undercooked meat
• Risk of passing infection to neonate (neurologic, IUGR, etc)
o O- Other (syphilis, hep B, cox sakie, Epstein- Barr, zoster) o R- Rubella
German measles…spread by droplet or direct contact
• Transmitted through placenta
• Education is key…screened on first prenatal visit with titer
• Immunize…MMR vaccine (live virus) not during a pregnancy
• Rubella titer of 1:8 acceptable to give immunity
o C- Cytomegalovirus – education is key
Leading cause of congenital infection
Prenatal screening not routinely performed
Greatest risk in first trimester
May have serious complications…hearing loss, intellectual, clinical
appearance, microcephaly
Many women during lifetime exposed & asymptomatic …may have titer
Acquire from sexual, kissing, blood transfusions, day care centers
Pregnant women…Hygiene guidelines-handwashing, diaper changes,
contact with urine, body secretions, pacifiers
Newest research-Send urine of newborn with failed hearing screen
,
Child Failing hearing screening is a red flag that they could of be
exposed in utero
o H-Herpes/HIV
Risk great during pregnancy/delivery
Zidovidine (ZDV) therapy pregnancy/labor if HIV positive
Breast feeding increases risk of transmission…advise against
With appropriate therapies, newborns usually do not become HIV positive o 5
categories
can cause a cluster of birth defects in newborn
• liver and spleen swelling
• encephalopathy
• microcephaly
• developmental issue
• intrauterine growth issues
o Blood test-titer
measures level of infant’s antibodies in response to specific agent
May indicate further testing (CSF or urine of NB)
STD’S/STI’S
o “Disease caused by microorganism transmitted through vaginal, anal, or oral
sexual intercourse” (CDC,2012) o Threat to sexual and general health
o Can become epidemic
o Millions live with an incurable STI o Sex with partners…who are partners? How
many partners?
o Complications more often in women than men
o Contribute to cancer, infertility, ectopic pregnancy, pain, death o Transmission
to fetus during pregnancy or delivery o Adolescents at greater risk…each year 4
million new cases(AMA, 2012)
o Elderly at increased risk
DIAGNOSTIC TESTING…STD/STI’S o Thorough history of present illness
o Risk factors present/past o Pelvic exam…genital lesions o Oral exam-
