Care Of The Obstetric Pt Flashcards
What are the changes to the heart rate of a pregnant pt?
Increased heart rate
What are the changes in cardiac output in a pregnant pt?
Pt needs to go to the loo more
Can lead to heart failure
What are the changes caused by the uterine blood flow for a pregnant pt?
Baby takes 10% of cardiac output
Can lead to rapid haemorrhage
What do you do when a pregnant pt has a cardiac arrest?
Don’t lay the pt in her side
Tilt, lay on side or push bump to left
You have 4 mins to get baby out
Only have 30 secs to intubate before the pt becomes hypoxic
What are the direct causes of death related to pregnancy?
Pre-eclampsia
Haemorrhage
What are the indirect causes of death?
Other conditions not related to pregnancy
What are the ECG changes in a pregnant pt?
The heart shifts and the apex is tilted to the left = inverted T wave
What are the blood changes in a pregnant women?
They differ in every trimester
What are the 4 specific conditions to be aware of?
- Pre eclampsia
- Post partum haemorrhage
- Sepsis
- Cardiac
What does pre eclampsia cause?
Increased BP and protein urea (if systolic is >150, give antihypotensives)
Kidneys shut down
Subarachnoid stroke
Factor is released from placenta due to the placenta not getting enough blood
Endothelium cell damage causing an increase in inflammation and clotting
Fluid shift causing moon face
Hypovolaemia
What are the symptoms of pre-eclampsia?
Brain vasospasms (headaches that aren't stopped by analgesia, seeing things, seizures) Liver hypoxia/damage (ruptured liver, swelling, pain)
What are the complications of pre-eclampsia?
Eclampsia (fitting)
What are the fetal complications of pre-eclampsia?
Low fluid around baby
Preterm birth
What are nursing care and awareness for pre eclampsia?
Headaches
Flashing lights
Increased BP
Protein urea in dipstick test
What are the 2 causes of postpartum haemorrhage?
Tone - uterus not contracting down
Trauma - peritoneal trauma, vaginal wall trauma
What is the treatment for postpartum haemorrhage?
Uterine tamponade
What is the treatment for per eclampsia?
Early delivery is not a cure as the women will still have the hormones in her body for 24-48 hrs post delivery
How do pregnant pt prevent genital tract sepsis?
They need to wash their hands before touching any tears
What should pregnant pts do if they develop d+v?
They need to be seen within 24 hrs of onset
What are the 3 stages of birth?
1st stage: dilation 10cm
2nd stage: delivery
3rd stage: delivery of the placenta and management of bleeding
What are the cardiac issues during the 3rd stage of birth?
Increased cardiac output leading to increased chance of bleeding
What is important remember about diabetes and a pregnant pt?
Women become naturally resistant to insulin so that the baby gets glucose Can develop gestational diabetes Will lose signs of having a hypo Doubles risk of miscarriage Baby sometimes makes more glucose
What is important to remember about pregnant women and asthma?
The severest stage is at 29-36 weeks (progesterone peak)
They need to continue drugs as normal
Key is to
Manage symptoms
What is important to remember about pregnant pts and sickle cell?
The pts may not recognise the symptoms
Can be forced into having a crisis
Ripping, nawing pain
Avoid pethidine - give diamorphine
What should you do if you have any problems with a pregnant pt?
Call the obstetrics team asap!!!!
What are the changes in plasma volume in a pregnant pt?
Haemadilation
Increase in clotting factors
Protective
Reduced O2 carrying capacity
