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NUR 514: Maternal-Newborn > Care of the High Risk Antepartum Patient (starting this not finishing yet) > Flashcards

Care of the High Risk Antepartum Patient (starting this not finishing yet) Flashcards

1
Q

What is preterm labor?

A
  • labor (cervical change) between 20 and 36 6/7 weeks gestation
  • leading cause of fetal/infant mortality and morbidity in US
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2
Q

Signs and symptoms of preterm labor

A
  • more than 6 uterine contractions in an hour with or without pain
  • cramping
  • pressure
  • leaking of fluid
  • backache
  • increased discharge esp pink tinged
  • “just not feeling well”
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3
Q

Risk factors of preterm labor

A
  • prior history of incompetent cervix or preterm delivery
  • extremes of age
  • infections: BV, STI, HPV
  • multiple pregnancy
  • abdominal trauma, surgery
  • 3 or more elective abortions
  • stress (physical or chronic psychological)
  • Lifestyle factors:
    – poor nutrition
    – smoking
    – substance use
    – long work hours
  • short pregnancy intervals
  • Non-Caucasian race, esp African-American
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4
Q

Self-care to prevent preterm labor and preterm birth

A
  • obtain good prenatal care
  • adequate rest, hydration, and nutrition
  • smoking cessation, treatment for substance use
  • avoid heavy lifting, shorten work hours
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5
Q

Diagnosis of preterm labor

A
  • measurement of cervical length (transvaginal ultrasound)
  • fetal fibronectin (testing presence; if positive - greater chance of delivery but not definite yes)
  • cervical exam
  • external fetal monitoring
  • also palpating uterine contractions
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6
Q

Management of Preterm labor

A
  • cervical insufficiency: cerclage (sewing cervix shut)
  • IV hydration
  • bedrest
  • tocolysis
  • administration of agents to improve neonatal outcomes
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7
Q

What medications are administered in tocolysis in management of preterm labor

A
  • magnesium sulfate (helps with contractions)
  • terbutaline
  • nifedipine
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8
Q

What medications/agents are used to improve neonatal outcomes in the management of preterm labor?

A
  • magnesium sulfate (neuroprotective agent)
  • betamethasone (improves lungs)
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9
Q

What is the nursing care r/t preterm labor?

A
  • education/prevention (warning signs, prevention)
  • assessment (uterine activity and fetal wellbeing)
  • monitoring for adverse effects of tocolysis
  • preventing complications of bedrest
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10
Q

What is PPROM?

A

Preterm Premature Rupture of Membranes

Rupture of the amniotic sac prior to 37 weeks gestation

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11
Q

What are signs and symptoms of PPROM?

A
  • leaking of fluid from the vagina (gush or trickle)
    – can have ferning of the fluid on a slide
  • oligohydramnios (decreased amniotic fluid)
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12
Q

What is the management of PPROM?

A

Active vs expectant management: depends on gestation age and risk or presence of infection

  • prevention of infection
  • bedrest
  • assessment of uterine activity, fetal wellbeing
    – watch for cord prolapse
  • administration of agents to improve neonatal survival if fetus is viable (mag. sulfate, betamethasone)
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13
Q

What is the nursing care for PPROM?

A
  • education:
    – warning signs
    – hygiene to prevent infection
    – anticipatory guidance
  • external fetal monitoring
    – minimize vaginal exam
  • communicate changes to provider
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14
Q

What are the types of hypertensive disorders in pregnancy?

A
  • chronic hypertension
  • gestational hypertension
  • preeclampsia
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15
Q

When is chronic hypertension? Signs? Treatment?

A

Before 20 weeks

Asymptomatic; increased BP

Treated with:
- labetolol (beta blocker)
- nifedipine (calcium channel)
- methyldopa

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16
Q

What is gestational hypertension/when diagnosed? Sign? Treatment

A

After 20 weeks
Only symptom is increased BP (over 140/90)
Treatment:
- labetolol (beta blocker)
- nifedipine (calcium channel)
- methyldopa

17
Q

When is preeclampsia diagnosed? Signs? Treatment?

A

It is an inflammatory response causing vasospasm

After 20 weeks
Multiple organ systems involved
Treatment depends on with or without severe features

18
Q

What are risk factors of preeclampsia?

A
  • pre-gestation hypertension or diabetes
  • obesity
  • extremes of age
  • first pregnancy or new paternity
  • multiple gestation
  • history of preeclampsia
19
Q

What is important with the assessment of women with preeclampsia?

A
  • accuracy in BP measurement is essential
    – check unexpected findings with manual
  • urine for proteins, platelets, liver enzymes, and creatinine
    – platelets decreased, liver enzymes increased
  • assess for headaches, blurred vision, epigastric pain, severe N/V
  • edema particularly hands, feet, face
  • DTRs: hyperreflexia; scaled 1-4
  • clonus (dorsiflex foot and it taps while moving out; usually done before seizing)
20
Q

What is done in prevention of preeclampsia?

A

Control of pre-existing conditions:
- chronic HTN
- obesity
- diabetes
Low-dose aspiring in high risk women
- usually 81 mg/day around 12 weeks and up

21
Q

What are the maternal risks of severe preeclampsia?

A
  • HELLP syndrome (hemolysis, elevated liver enzymes, low platelets)
  • renal failure
  • placental abruption
  • pulmonary edema (SOB, hypervolemia)
  • eclampsia (seizures)
  • stroke/MI
    – stroke tends to be hemorrhagic
  • death

2nd leading cause of death globally for mothers

22
Q

What are the fetal risks of severe preeclampsia?

A
  • prematurity
  • intrauterine growth restriction (IUGR: smaller baby)
  • oligohydramnios (no BP, no peepee)
  • death related to placental abruption [or poor blood flow]
23
Q

What is Preeclampsia without Severe Features?

A
  • elevated BP: 140/90
  • proteinuria, other labs WNL
    – CBC, LFT, creatinine
  • edema

Expectant management:
- education on danger signs (headache, blurred vision, pain on RUQ, N/V)
- increased maternal/fetal surveillance (NST 2x/wk, BPP, kick counts)
- delivery at 37 weeks

24
Q

What is Preeclampsia with Severe Features?

A
  • severe range hypertension: 160/110
  • persistent headache or visual disturbance
  • epigastric pain (RUQ)
  • HELLP syndrome
  • worsening renal function (elevated creatinine, oliguria)
    – creatinine normally 0.6-1.0 (1.1-1.2 is sus)
    – oliguria: less than 30mL urine/hr
  • non-reassuring fetal testing
25
Q

What is nursing care of the woman with severe preeclampsia?

A
  • monitor for s/s of worsening preeclampsia
  • decrease environmental stimuli
  • seizure precautions
  • if hypertensive crisis:
    – hydralazine or labetalol IV push
    – nifedipine oral has been added
  • fetal monitoring
  • monitor labs: platelets, AST, ALT, LDH, creatinine
  • administer magnesium sulfate (neuroprotective for baby)
26
Q

What is magnesium sulfate?

A

Decreases risk of eclampsia (seizures)
- decreases excitability across neurons
- do mag checks every hour

Normal levels: 1.5-2.5

27
Q

What are the normal levels for magnesium?

A

1.5-2.5

28
Q

What are the therapeutic ranges of magnesium for preeclampsia?

A

4-7

29
Q

At which level do you have risk of toxicity for magnesium?

A

level above 8

30
Q

What are signs of toxicity with magnesium?

A
  • hyporeflexia (or absent reflexes)
  • decreased respiratory rate
  • oliguria
  • decreased LOC
31
Q

What can magnesium toxicity lead to?

A
  • respiratory depression
  • pulmonary edema
  • renal failure
  • coma/death
32
Q

What is the antidote for magnesium sulfate?

A

Calcium Gluconate
- needs to be readily available

33
Q

What is included in the care of the woman receiving magnesium sulfate therapy?

A

Administration of magnesium sulfate:
- 4g bolus of 20 minutes
- 2g/hr maintenance
Hourly “mag checks”
- I/O, DTRs, LOC, respiratory assessment
Stat Mag. level if s/s of toxicity is present
Have calcium gluconate available

Side effects: patient feels hot, “flu-ish”

NUR 514: Maternal-Newborn (2 decks)

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