80% Flashcards
What is the treatment for GBS?
Penicillin G - 4 hour limit - Give drugs before birth to kill GBS for birth because it grows back fast
PROM consideration
Limit Vag exams
Record - time amount color order
PROM complications
Chorioamnionitis - infection & Cord prolapse
Normal A1C
6.5. Or less
Gestational Diabetes insulin needs
1st Trimester - Low
2nd Trimester - High
3rd Trimester - High
Labor and delivery - Low, baby doesn’t have moms glucose, so they are prone to hypoglycemic
Obesity Complications
Increased - C section time, blood loss, infection risk, DVT
BMI Review
Underweight - less than 18.5
Normal - 18.5 to 24.9
Overweight - 25 to 29.9
Obese - greater than 30
Severely Obese - greater than 40
Gestational HNT
After 20 weeks onset, 140/90, NO proteinuria
Pre-eclampsia
After 20 weeks, 140/90, Proteinuria
Deliver baby in severe cases to lower the BP
Eclampsia
Involves Seizures and Coma that can occur during and up to 48 hours after birth
Chronic HNT
Present before 20 weeks but can become pre-eclampsia
HNT Nursing Considerations
Calm environment, seizure pre, assess Edema, assess tendon reflexes, assess lab values
HNT Pharmacology
Hydralazine, Labetalol, Magnesium Sulfate
Magnesium Sulfate
This med is a high alert seizure preventing med
Look out for respitory depression, decreased reflexes
1st action of OD is turn off pump
Antidote - Calcium Gluconate,
HNT effects on fetus
Growth restriction, low amniotic fluid, PTB, late acceleration due to abnormal O2
HELLP Syndrome
Laboratory Diagnosis, sever pre-eclampsia
H- hemolysis
EL - elevated liver enzymes
LP - low platelet
Antepartum testing
Fetal movement, ultrasound, doppler blood flow analysis, amniotic fluid index, Biophysical BPP, Non stress test
Biophysical Profile BPP
AFI, Fetal HR, Fetal Movement, Fetal Tones, Fetal Breathing
Normal 7-10
Hyperemesis Gravidarum
S&Sx - weight loss, dehydration, low BP, high pulse, can’t keep liquids down
Interventions - obtain weight, Vital signs, Urine analysis, blood work for electrolytes
Treatment - IV therapy, B6, Zofran, dairy, dry starchy foods, high protine snacks, ginger, fresh air
Miscarriage types
Threatened - could happen, spotting blood
Inevitable - will happen, bleeding and cramping
Incomplete - baby is lost & out, life threatening bleeding from placenta or tear
Complete - Baby is visible in the toilet with minimal bleeding
Missed - 2nd trimester, Baby has no HR and is dead inside of mom
Ectopic pregnancy
S&Sx - bleeding, pain, positive pregnancy test,
Screening - HCG level, transvaginal ultrasound
Ectopic management
Medical - Methotrexate blocks DNA synthesis
Surgical - removal whole tub or a piece - affects future fertility
Both - use birth control for 3 months
Molar Pregnancy
Rare placental growth In the uterus, it develops into Choriocarcinoma
Molar management
Most of the time, spontaneously abort or use suction to pull it out
Ultrasound
HCG levels watched for a year no pregnancy
Placenta Previa
Placenta covers the cervical OS
Found by ultrasound & Painless bright red bleeding
No vaginal exams
Baby will be C-section
Placenta Accreta
Placenta grabs the uterus muscles and doesn’t separate easily
Placenta Percreta
Placenta is rooted into moms organs
Placenta Abroption
Separation of the placenta after 20 weeks from trauma
S&Sx - abdominal pain, dark vaginally bleeding, urine tenderness, ultrasound diagnostic, uterus rigidity
RF - Trauma, Hypertension, Coke, Smoking, Twins
DIC
This is when you are bleeding so fast that the body loses its closing factors, causes body wide bleeding
Trauma management
Fetal and contraction monitoring, ultrasound, Labs, Rhogam injection
PTL Risk Factors
History of PTB, multi gestation, Utrin / cervical changes,
Bleeding, infections, underweight, obesity, increased BP
No care, smoking, substance abuse, DV, sexual abuse
Preterm Birth Factors
History of PTB
Fetal Fibronectin FFN - nothing in Vag for 24 hours
Cervical Length - less then 15 mm
Preterm Labor Signs
Contraction every 10 minutes, rupture of membranes, bleeding, low dull back pain, cramps that are menstral like, potential diarrhea
PTL Meds
Magnesium Sulfate - nuro protection, delays labor
Betamethazone - promos fetal lung development
Tocolytics
Ibuprofen - decreased amniotic fluid after 32 weeks
Indocin - take with food or antiacid, decreased amniotic fluid after 32 weeks
Toroidal - iv or im
Nifedipine - watch for hypotension
Terbutaline - sub q, don’t give if client has a Tachy HR, this is a fast acting emergency med
Mag Sulfate - delay pregnancy, client will have hot flash, sweating, burning of iv site, n/v, muscle weakness
Betamethasone
2 injections 24 hours apart,
Contraindications- infection, hyperglycemic, hypertension
Cervical Cerclage
Done in the 12 to 14th week, it’s a stich that holds the cervix together and has to be taken out before birth
Genetic prenatal tests
Family history, Maternal serum screen, Fetal ultrasound, Amniocentesis - pull water with a needle at about 14 weeks
Chronic Villus Sampling - Pull a chunk of placenta tissue to test
Prenatal v.s Preconception
Preconception - is your state of health before you come pregnant
Prenatal - appointment should be made after your 1st missed period
Nutrition Key points
Inc. Protein, 8 to 10 glasses of water, no more than 200mg of caffeine daily, vegans need B12
Foods to avoid in pregnancy
Unprocessed dairy
Aged meat and cheese
Deep sea big fish tuna, sword fish
Iron rich foods & Calcium rich foods
iron - leffy green vegetable, vitamin C helps absorb iron
Calcium - milk, cheese, yogurt, sardines
Pica
This is the consumption of non food items due to low hemoglobin
Naegele’s Rule
Last menstrual period date
Subtract 3 months
Add 7 days
Equals due Date
Presumptive signs
Changes felt by the mom
Probable signs
Changes observed by examiner
Gooddell sign - soften cervical tip
Chadwick sign - deep color of vag
Hegar sign - softening and compressabilty of lower urine
Ball sign - tap on cervix and baby jumps
Positive sign
Signs that are atrubited to only the presence of a fetus
Pre-embryonic
2 weeks of the zygote
Embryonic
Most venerable to Toraogens from 2 to 8 weeks
Fetal period
8 to 40 weeks, viability is possible at 24 weeks
Placenta hormones
HCG - biomarker of pregnancy, produces progesterone and estrogen till placenta assume function
Estrogen - increases vascular, growth
Progesterone - maintain the pregnancy, relaxation of smooth muscles
HPL - increased availability to glucose
Relaxin - relaxes pelvic joints, inhibits utrin activity
Oligonhydramnios
Not enough amniotic fluid
Polyhyamnios
To much amniotic fluid
Teratogens
Drugs, Chemicals, Infection, Radiation, Alcohol
Placenta functions
Metabolic - respiration, diffuse of mom and fetal blood
Nutrition - water, electrolyte, carbs, fats, protein, vit
Excretion - waste out of fetal blood
Storage - stors nutrients in placenta for fetal need
Transfer Imm - gives the baby’s antibodies before birth
Week 4 & 5
CV is the 1st to form
4 chambers in the heart are formed by week 5
Week 8
Heart beat, all organs and structures are there, Fetal stage starts
Week 12
Heart beat can be heard with a doppler, gender becomes apparent
Week 20
Placenta is developed
Fetal movement can be felt by Mother 16-20
Week 24
Fetus becomes viable, hears, sees,
Week 32
Antibodies cross the placenta
Week 36
Lung development is almost complete
Week 40
There baby is ready to live outside and has a sleep wake cycle
