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Nursing Theory III > Care of Women with Complications During Pregnancy > Flashcards

Care of Women with Complications During Pregnancy Flashcards

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1
Q

Nursing Responsibilities

A

Preparing the patient properly
Explaining the reason for the test
Clarifying and interpreting results in collaboration with other health care providers

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2
Q

Danger Signs in Pregnancy

A 
Sudden gush of fluid from the vagina 
Vaginal bleeding
Abdominal pain
Persistent vomiting
Epigastric pain
Edema of face and hands
Severe, persistent headache
Blurred vision or dizziness
Chills with fever over 38.0º C (100.4º F)
Painful urination or decreased urine output
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3
Q

Pregnancy Related Complications

A 
Hyperemesis gravidarum
Bleeding disorders
Hypertension
Blood incompatibility between mother and fetus
Medical disorders - DM
Infections - TORCH
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4
Q

Hyperemesis Gravidarum: Treatment

A 
Correct dehydration and electrolyte or acid-base imbalance (may be hypokalemic) 
Antiemetic drugs may be prescribed
In extreme cases:
- TPN may be required
- Hospitalization
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5
Q

Nursing Care of Early Pregnancy Bleeding Disorders

A

Document amount and character of bleeding
Save anything that looks like clots or tissue for evaluation by pathologist
Perineal pad count with estimated amount of blood per pad (50%)
Monitor VS
If actively bleeding, woman should be kept NPO in case surgical intervention is needed

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6
Q

Post-Abortion Teaching

A

Report increased bleeding
Take temperature every 8 hours for 3 days
Take an oral iron supplement if prescribed
Resume sexual activity as recommended by HCP
Return to the HCP at the recommended time for a check up and contraception information
Pregnancy can occur before the first menstrual period returns after the abortion procedure

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7
Q

Emotional Care

A

Spiritual support from someone of the family’s choice and community support groups may help the family work through the grief of any pregnancy loss

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8
Q

Ectopic Pregnancy: Treatment

A 
Pregnancy test
Transvaginal ultrasound
Laparoscopic examination
Priority is to control bleeding
Monitor for signs of hypovolemic shock
Keep NPO is surgery is suspected 
Three actions can be taken:
- No action
- Treatment with methotrexate to inhibit cell division 
- Surgery to remove the pregnancy from the tube
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9
Q

Signs and Symptoms of Hypovolemic Shock

A

Changes in fetal HR (increased, decreased, less fluctuation)
Rising, weak pulse (tachycardia)
Rising respiratory rate (tachypnea)
Shallow, irregular respirations; air hunger
Falling blood pressure (hypotension)
Decreased or absent urinary output (30 ml/hr)
Pale skin or pale mucous membranes
Cold, clammy skin
Faintness
Thirst

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10
Q

Care of the Pregnant Woman with Excessive Bleeding (Late pregnancy)

A 
Document blood loss
Closely monitor VS, I&O
Observe for:
- Pain
- Uterine rigidity or tenderness
Verify that orders for blood typing and cross-match have been carried out
Monitor IV infusion
Treatment .. Maintain until 34 weeks if possible
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11
Q

Treatment (Excessive Bleeding)

A

Lie on side with pillow under hip to decrease supine hypotension
Try to decrease stress as much as possible
Delivery is ordered to decrease mortality
- C-section (partial or total placenta prevue and abruptio placenta if there is risk of maternal shock, clotting disorders, or fetal death)
May have to administer blood or clotting factors

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12
Q

Care of the Pregnant Woman with Excessive Bleeding (Late pregnancy)

A 
Prepare for surgery, if indicated (NPO)
Monitor fetal heart rate and contractions
Monitor lab results, including coagulation studies
Administer oxygen by mask
VS
NO VAG EXAM
Prepare for newborn resuscitation
Support for grieving family
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13
Q

Management of GH

A

Depends on the severity of hypertension and on the maturity of the fetus
Treatment focuses on:
- Maintaining blood flow to the woman’s vital organs and placenta
- Preventing convulsions (eclampsia)
BIRTH IS CURE FOR GH

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14
Q

Conservative Treatment

A

Activity restriction
Maternal assessment of fetal activity
BP monitoring
Daily weight (diet)
Checking urine for protein
Drug therapy
- Magnesium sulfate (anticonvulsant therapeutic level is 4-8 mg/dl); inhibits contractions; must have good output; drowsy, maintains DTRs and respirations
- Calcium gluconate (reverses the effects of magnesium sulfate and should be available)
- Antihypertensives (levels higher than 160/100 mm/Hg

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15
Q

Nursing Care Focus

A

Assisting the woman in obtaining prenatal care
Helping her cope with therapy
Caring for acutely ill woman
- Know what signs/ symptoms to monitor for and when to intervene
Administering medications as prescribed

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16
Q

Bleeding Incompatibilities

A

Rh-negative blood type is an autosomal recessive trait
Rh-positive blood type is a dominant trait
Rh incompatibility can only occur if the woman is Rh-negative and the fetus is Rh-positive

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17
Q

Isoimmunization

A

The leaking of fetal Rh-positive blood into the mother’s Rh-negative circulation, causing her body to respond by making antibodies to destroy the Rh-positive erythrocytes
With subsequent pregnancy, the woman’s antibodies against Rh-positive blood cross the placenta and destroy the fetal Rh-positive erythrocytes before the infant is born

18
Q

Erythroblastosis Fetalis

A

Occurs when the maternal anti-Rh antibodies cross the placenta and destroy fetal erythrocytes
Requires RhoGAM to be given at 28 weeks and within 72 hours of delivery to the mother
- Also given after amniocentesis, and if woman experiences bleeding during pregnancy
Fetal assessment tests must be done throughout pregnancy
An intrauterine transfusion may be done for the severely anemic fetus

19
Q

Factors Linked to GDM

A

Maternal obesity (>90 kg or 198 lb)
Large infant (>4000 g or 9 lb)
Maternal age older than 25 years
Previous unexplained stillbirth or infant having congenital abnormalities
Hx of GDM
Family Hx of DM
Fasting glucose level over 126 mg/dl or post meal glucose level over 200 mg/dl

20
Q

Treatment of GDM

A

Identification of GDM (routine 140 mg/dl or higher)
Diet (3 meals 2 snacks)
Monitoring blood glucose levels (PRN throughout the day, teach S&S of hypo/hyperglycemia)
Ketone monitoring (need for more carbohydrates, develop ketoacidosis (hyperglycaemia))
- Vomiting, dehydration, deep gasping breaths, confusion and may lead to death
Exercise
Insulin injections (may be used to reduce hypoglycaemia)
Fetal assessment (fetal growth, placental insufficiencies, amniotic fluid)

21
Q

Care During Labor of the Woman with GDM

A

IV infusion of dextrose may be needed
Regular insulin
Assess blood glucose levels hourly and adjust insulin administration accordingly
Close monitoring of fetus (c-section may be indicated if in distress)

22
Q

Care of the Neonate of the Woman with GDM

A

May have the following occur
- Hypoglycemia
- Respiratory distress
Injury r/t macrosomia
Blood glucose monitored closely for at least the first 24 hours after birth
Breastfeeding should be encouraged (Lowers incidence of DM later in life)

23
Q

Iron Deficiency Anemia

A

RBCs are small (microcytic) and pale (hypochromic)
Prevention:
- Iron supplements
- VC may enhance absorption
- Do not take iron with milk or antacids (calcium impairs absorption)

24
Q

Iron Deficiency Anemia: Treatment

A

Oral doses of elemental iron (ferrous fumerate 33%)

Continue therapy for about 3 months after anemia has been corrected

25
Q

Folic Acid Deficiency Anemia

A

Large, immature RBCs (megaloblastic anemia)
Anticonvulsants, oral contraceptives, sulpha drugs, and alcohol can decrease absorption of folate from meals
Folate is essential for normal growth and development
Prevention:
- Daily supplement of 400 mpg (0.4 mg)

26
Q

Folic Acid Deficiency Anemia: Treatment

A

Folate deficiency is treated with folic acid supplementation
1 mg/day (over twice the amount of the preventive supplement)
- Dose may be higher in woman who have had a previous child with a neural tube defect

27
Q

Nursing Care for Woman with Anemias During Pregnancy

A

Teach woman which foods are high in iron and folic acid
Teach woman how to take supplements
- Do not take iron supplements at the same time as drinking milk
- Do not take antacids with iron
- When taking iron, stools will be dark green to black

28
Q

Nursing Care for Woman with Anemias During Pregnancy

A

The woman with sickle cell disease requires close medical and nursing care

  • Teach her to prevent dehydration and activities that cause hypoxia
  • Teach her to avoid situations where exposure to infection are more likely
  • Teach her to promptly report any signs of infection
29
Q

Infections

A

Acronym TORCH use to describe infections that can be devastating to the fetus or mother

  • Toxoplasmosis
  • Other infections
  • Rubella
  • Cytomegalovirus
  • Herpes
30
Q

Viral Infections

A

No effective therapy
Immunizations can prevent some infections
Rubella: 3 months before or in postpartum period
CMV: there is no effective treatment, therapeutic pregnancy termination may be offered if discovered early in pregnancy
- mental retardation
- seizures
- blindness
- deafness
- dental abnormalities
- petechiae

31
Q

Herpes Virus: Treatment and Nursing Care

A

Avoid contact with lesions
- If woman has active genital herpes when membranes rupture or labor begins
Cesarean delivery may be required if lesions are present at time of delivery
Mother and infant do not need to be isolated as long as direct contact with lesions is avoided
Widespread neonatal infection has a high mortality rate and survivors may have neurological deficits

32
Q

Hepatitis B

A

Transmitted by blood, saliva, vaginal secretions, semen, and breast milk; can also cross the placenta
Fetus may be infected transplacentally or by contact with blood or vaginal secretions during delivery
Upon delivery, the neonate should receive a single dose of hepatitis B immune globulin, followed by the hepatitis B vaccine

33
Q

Nursing Care HIV

A

Educate the woman who is HIV positive on methods to reduce the risk of transmission to her developing fetus/ infant (antiretrovirals - suppress HIV)
Pregnant woman with AIDS are more susceptible to infections
Breastfeeding is contraindicated for mothers who are HIV positive
Neonates presumed to be HIV positive

34
Q

Toxoplasmosis

A

Treatment
- Therapeutic abortion
Preventive measures
- Cook all meat thoroughly
- Wash hands and all kitchen surfaces after handling raw meat
- Avoid uncooked eggs and unpasteurized milk
- Wash fresh fruits and vegetables well
- Avoid materials contaminated with cat feces

35
Q

Other Infections

A

STIs
- Protected sexual contact
- Treated when possible
UTIs
- Antibiotics: oral or IV
- Teaching re: how to reduce
- Adequate fluid intake to increase urination
- Urinating pre and post sexual intercourse
- Teach S&S of cystitis or pyelonephritis

36
Q

Environmental Hazards During Pregnancy

A

Substance Abuse
- Questions should focus on how the information will help nurses and physicians provide the safest and most appropriate care to the pregnant woman and her child
Alcohol
- A single episode of consuming two alcoholic drinks can lead to the loss of some fetal brain cells

37
Q

Trauma During Pregnancy

A 
3 leading causes of traumatic death:
- Automobile accidents
- Homicide
- Suicide
Battering
Bruises in various stages of healing
38
Q

Nursing Tip

A

If a woman confides that she is being abused during her pregnancy, this information must be kept absolutely confidential
Her life may be in danger if her abuser learns that she told someone
She should be referred to local shelters, but the decision to leave her abuser is hers alone

39
Q

Effects of a High-Risk Pregnancy on the Family

A

Disruption of usual roles
Financial difficulties
Delay attachment to the infant
Loss of expected birth experience

40
Q

Interventions for the Grieving Process

A

Allow parents to remain together in privacy
Accept behaviours r/t grieving
Develop a plan of care to provide support to the family
Offer a memento such as a footprint
Offer parents an opportunity to hold the infant, if they choose
Prepare parents for the appearance of the infant
Provide parents with educational materials and referrals to support groups
Discuss wishes concerning religious and cultural rituals

Nursing Theory III (17 decks)

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