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Clinical Topic #4
Objectives:
Discuss the impact on parents and families with the birth of the imperfect infant or an infant that has died. Explore nursing interventions to assist parents and families with their grief. Identify sexually transmitted infections & their potential impact upon pregnancy.
Perinatal Loss
Abortion Fetal Demise Neonatal Demise Loss of the perfect child
GRIEF RESPONSES
Shock & numbness - stunned & disbelief Searching & yearning restless, anger, guilt Disorganization depression, realizes loss Reorganization able to cope with loss and finally move on
Memory Box
Door Card
Anticipatory Grief
If the parents know that their child will have a deformity or know of an impending loss, such as when an infant is admitted to the NICU, being able to anticipate the loss will give the families an opportunity to feel more in control of their situation and give them time to say good-bye in a special way.
Diagnosis: symptoms and wet mount Treatment: miconazole cream external or intravaginal
Trichomoniasis
Causative agent: Trichomonas vaginalis-An anaerobic flagellated protozoan Sexually transmitted Asymptomatic or mild symptoms:
Yellow-green, frothy, odorous discharge Vulvar itching Possible dysuria or dyspareunia
Chlamydia
The most common STI in the US Bacteria organism: Chlamydia trachomatis Sexually transmitted Symptoms
Thin or mucopurulent discharge Friable cervix Burning & frequency with urination
Gonorrhea
Bacterial organism: Neisseria gonorrhoeae Sexually transmitted Symptoms:
Men are more symptomatic 80% of women are asymptomatic Green-yellowish discharge Urinary frequency and dysuria
Herpes Simplex
Viral organism: HSV-1 and HSV-2 Transmission:
Vaginal, anal, or oral sex Skin-to-skin contact with an infected site
Diagnosis:
Clinical appearance of lesions Lesion culture
Herpes Simplex
Symptoms: primary outbreak Single or multiple blister like vesicles Difficult urination and urinary retention Enlargement of inguinal lymph nodes Flu like symptoms, genital pruritus, or tingling Primary lesions heal and the virus lies dormant Recurrences vary from none to regular occurrances Recurrences can be triggered by stress, illness or pregnancy Treatment: oral acyclovir or valacyclovir during outbreaks or suppressive No cure
Syphilis
Bacterial organism:
Treponema pallidum
Transmission:
Sexual contact Exposure to exudate from infected individual Transplacental
Syphilis (contd)
Symptoms: early stage
Chancre appears, lasts for 4weeks then disappears Fever weight loss malaise
Diagnosed by visual inspection Treatment: Possible surgical removal, cryotherapy or patient applied therapies
Hepatitis B
Causative agent: Hepatitis B virus Transmission: Blood borne, sexual or perinatal Diagnosis: Serum testing for HBsAg (Hepatitis B Surface Antigen) Hepatitis B is a chronic disease, there is no cure
HIV
HIV is transmitted via blood/body fluids and sexual contact CDC recommends that all pregnant women be screened for HIV Women who have not been screened should have a rapid HIV drawn upon labor admission HIV transmission to the neonate can occur by
Transplacental Breastfeeding Exposure to contaminated blood
DISEASE
ORGANISM
TREATMENT Metronidazole or Clindamycin Amoxicillin or Azithromycin Surgical or laser removal of warts Amoxicillin or Azithromycin Acyclovir
PREGNANCY IMPLICATIONS PROM, PTL, amniotic infection & Post partum endometritis PTL, neonatal opthamic infection
Bacterial Vaginosis
Gardnerella Vaginalis Chlamydia Trachomatis Papovavirus Neisseria Gonorrhoeae Herpes Simplex Virus Phthirus Trichomonas Vaginalis Treponema Pallidum Candida Albicans
Chlamydia
Lesions on the vulva, vagina, cervix or anus Vaginal inflammation & purulent vaginal discharge
Link between HPV and cervical cancer Active infection at birth can cause opthalmia neonatorum Vaginal birth possible only if no active lesions. None, if treated during pregnancy Increased risk for PTL & PROM
Herpes Genitalis
Lesions only if active, inactive asymptomatic with elevated herpes titer Profuse perineal itching. Microscopic ID of lice or nits Frothy green vaginal discharge
Permethrin shampoo
Pediculosis Pubis
Metronidazole
Trichomonas
Syphillis
Primary: Chancre Secondary: skin rash. Diagnosed with blood tests Thick, white, curdy discharge. Perineal itching
Benzathine Penicillin G IM
Can be passed transplacentally to the fetus. Risk for stillbirth, abortion, congenital syphilis If present at vaginal birth, infant may contract thrush
Vulvovaginal Candidiasis