CH 20 Flashcards
What are some conditions that cause at risk pregnancies?
diabetes
cardiac & respiratory disorders
anemia
autoimmune disorders
specific infections
Type 1 DM (pregestational)
insulin deficiency; appears prior to age 30 (juvenile diabetes)
Type 2 DM (pregestational)
insulin deficiency OR resistance; diagnosed after age 30
Gestational diabetes
glucose intolerance DURING pregnancy
Other hyperglycemia causes:
by disease process (cystic fibrosis, pancreatitis) or medication (glucocorticoid - steroids)
Steroids for the premature baby can cause hyperglycemia in the mother
DM effects on MOTHER
hydramnios
gestational hypertension
hypoglycemia
preterm labor
DM effects on FETUS
macrosomia
hypoglycemia
birth trauma
DM pathophysiology:
- fetal demands - baby pancreas takes over -too much sugar- kicking out sugar to control moms hyperglycemia. We dont want the baby to work that hard.
- role of placental hormones
- changes in insulin resistance
- effects on mom
- effects on fetus
DM Therapeutic Management
- preconception counseling: want mom to start out as healthy as possible.
- blood glucose level control (HbA1c < 7%) - if mom is known diabetic/ previous gest. diabetes then we want her HbA1c below 7.
- glycemic control
- nutritional management: want pt to see doc, NP, dietician
- hypoglycemia agents
- close maternal & fetal surveillance
- management during L&D: need to do blood sugar checks EVERY HOUR
- early induction 38-39 wks
What IVs can we hang for a mom with DM?
LR
NS
D5
DM Screenings
-at first prenatal visit (fasting glucose)
-additional screening at 24-28 weeks for women considered at risk (fasting glucose + GTT if elevated)
fasting blood glucose level: less than 95mg
1 hr: less than 140mg
2 hr: less than 120mg
3 hr: less than 95mg
if above any of those #s then may be diagnosed w/ gest diabetes
GTT (DM)
glucose tolerance testing
Maternal surveillance (DM)
check for:
-urine for protein
-ketones
-nitrates
-leukocyte esterase
-evaluation of renal function every trimester
-eye exam in 1st trimester
-HbA1c q4-6 wks
Fetal surveillance (DM)
check:
-ultrasound
-alpha-fetoprotein levels
-biophysical profile
-nonstress testing (towards the end)
-amniocentesis (if out of control)
DM Assessment for MOM - at risk for _____
-at risk for UTIs which can turn into pyelonephritis = go into early labor
Meds for DM Management
-insulin preferred
-glyburide
-metformin
**do not cross the placenta barrier
DM Mangement
-glucose control - meds
-nutritional therapy
-measures during labor & birth, postpartum
-prevention of complications
-client education + counseling
Congenital Heart Conditions Affecting Pregnancy
TOF - tetralogy of fallot
ASD - atrial septal defect
VSD - ventricular septal defect
PDA - patent ductus arteriosus
Acquired Heart Conditions Affecting Pregnancy
mitral valve prolapse
mitral valve stenosis
aortic stenosis
cardiomyopathy
MI
C&A Heart Disease: what to look for/what to do
-hemodynamic changes overstressing woman’s cardiovascular system.
-heart is working hard during pregnancy and some women end up in the ICU bc of the heart.
-do risk assessment, prenatal counseling, increased frequency of prenatal visits
-CHECK FOR: vital signs, heart sounds, weight (keep it under control), fetal activity, lifestyle
-s/s of cardiac decompensation
C&A Heart Disease: Nursing Management
- stabilization of hemodynamic status - may need to be at the hospital the whole time
- risk reduction measures: education/counseling/support - decrease stress & eat right
- cardiac meds if prescribed
- energy conservation; nutrition - may not be able to work or do their normal routine
- fetal activity monitoring
- s/s of cardiac decompensation - labor can put them into decompensation
- monitor during labor
Asthma Meds
budesonide
albuterol
salmeterol
Asthma
check: asthma triggers; lung auscultation
manage: do client education, oxygen saturation monitoring during labor
If mom is Status Asthmaticas then baby is…
baby has low amniotic fluid bc uterus is not getting oxygen so then baby is not getting enough oxygen - kidney not getting blood = not producing urine = baby not getting enough amniotic fluid
Iron Deficiency Anemia Caused by:
-due to inadequate dietary intake
manage by: eliminate s/s, correct deficiency, replenish iron stores
prenatal vitamins & iron supplement
-give mom stool softener bc prenatals & extra iron will make her constipated
Iron Deficiency Anemia S/S:
fatigue
weakness
malaise
anorexia
susceptibility to infection (frequent colds)
pale mucous membranes
tachycardia
pallor
Iron Deficiency Anemia: Abnormal Lab Results
low hemoglobin
low hematocrit
low serum iron
microcytic and hypochromic cells
low serum ferritin
Sickle Cell Anemia is:
a defect in hemoglobin molecule - S
Sickle Cell Anemia Management:
-dependent on status
-supportive therapy
-blood transfusions for severe anemia
-analgesics for pain
-antibiotics for infection
Sickle Cell Anemia S/S:
-anorexia
-dyspnea
-malaise
-sever abdominal pain
-leg pain
-muscle spasms
-joint pain
-fever
-stiff neck
-N&V
Sickle Cell Anemia Management:
-need lots of f/u appts, blood testing
-labor is difficult for them bc already in pain and then add labor pain
-dont want her bleeding too much, need to keep RBC
-increased risk for blood clots
Labor: rest, pain mgmt, oxygen, IV fluids, close FHR monitoring
PP: antiembolism stockings, family planning options
Localized Autoimmune Diseases
targets specific organs
-Hashimoto’s thyroiditis (HYPOthyroid)
-Graves’ disease (HYPERthyroid)
targets: thyroid gland
Systemic Autoimmune Diseases
targets multiple organs
-lupus erythematosus
targets: lung, heart, joints, kidneys, brain, RBC
lupus - high risk for the baby, do stress testing
Infections - list of names
- cytomegalovirus
- rubella (german measles)
- herpes simplex virus
- Hep B
- varicella zoster virus
- group B streptococcus
- Toxoplasmosis (Cats)
- HIV
Group B Streptococcus
- Gram + bacteria which colonizes GI & GU tract
-life threatening to newborns
-mom can have no symptoms
Group B Streptococcus is tested at which weeks?
35-37 weeks
Group B Streptococcus Tx:
-given during labor, penicillin G
-IVPB every 4 hrs and watch for s/s
-if mom allergic to penicillin then give clindamycin
Vulnerable Populations
-adolescents
-pregnant women over 35 yrs - AMA advanced maternal age
-Obese pregnant women - hard on the body, hard to deliver, high risk for c section
-women who have HIV
-women who abuse substances
HIV Positive
-threats to self, fetus, newborn
-every pregnant woman needs to have a HIV test but w/ consent
HIV Positive Therapeutic Management:
-NO breastfeeding
-oral antiretroviral drugs 2x daily from 14 wks till birth
-IV admin during labor
-oral syrup for newborn for 6 wks of life
-decision for birthing method
HIV Positive Assessment:
-history and physical exam
-HIV antibody testing
-test for STIs
HIV Positive Nursing Management:
-pretest/posttest counseling
-education
-support
-dr prefers c section (less blood than vaginal)
Pregnant Adolescent Assessment & Management
-vision of self in future
-role models, emo support
-level of child development education
-financials
-anger & conflict skills
-knowledge of health & nutrition for self and child
-community resources
-future planning (return to school, job)
-stress management, self care
Woman Over Age 35 Nursing Assessment:
-preconception counseling
-lifestyle changes
-beginning pregnancy in optimal state of health
-lab and diagnostic testing for baseline
-amniocentesis
-quadruple blood test screen
Woman Over Age 35 Management:
-promotion of healthy pregnancy
-education
-early and regular prenatal care
-diet
-continued surveillance
Pregnant Woman w/ Substance Abuse - 4 Impacts on Pregnancy
-fetal vulnerability
-teratogenic effect
-addiction consequences
-baby can go thru withdrawals
Pregnant Woman w/ Substance Abuse - Common Substances
- alcohol - FAS; FASD
- caffeine - cause low birth weight
- nicotine - cause low birth weight, constricts blood vessels
- cocaine - placental abruption
5.marijuana
6. opiates; narcotics – neonatal abstinence syndrome
7. sedatives
8. methamphetamines
Pregnant Woman w/ Substance Abuse : Baby Characteristics
-low nasal bridge
-short palpebral fissures
-short nose
-flat midface
-receding jaw
-thin upper lip
-minor ear abnormalities
-epicanthal folds
Pregnant Woman w/ Substance Abuse: Assessment & Management
-history and physical exam
-urine toxicology
-nonjudgmental approach
-state protection agency investigation for positive newborn
-counseling / education
-report to authorities if baby is + & they use a urine bag to collect the sample
