Ch. 9: Medical Conditions Flashcards
A variable condition whereby expulsion of the products of conception occur
Recurrent premature dilation of the cervix or cervical insufficiency
What are some subjective and objective data suggesting recurrent premature dilation of the cervix?
- Increase in pelvic pressure or urge to push
- Pink stained vag discharge or bleeding
- Possible ROM
- Uterine contractions with the expulsion of fetus
What indicated reduced cervical competence?
- Ultrasound showing short cervix (less than 25 mm in length)
- Presence of cervical funneling (breaking)
- Effacement of cervical os
What is prophylactic cervical cerclage?
Surgical reinforcement of the cervix with a heavy ligature that is placed submucousally around the cervix to strengthen it and prevent premature cervical dilation
-Best results if done before 23-24 weeks gestation; cellarage is removed at 37 weeks or when labor begins
Recurrent premature dilation of the cervix: What can be given prophylactically to inhibit uterine contractions?
Tocolytics
Recurrent premature dilation of the cervix: What are the discharge instructions?
- Activity restriction/bedrest
- Hydration to promote relaxed uterus (dehydration stimulates uterine contractions!)
- Refrain from sex; monitor cervical/uterine changes
Excessive nausea and vomiting (possible r/t elevated hCG levels) that is prolonged past 12 weeks gestation and results in 5% weight loss from pre pregnancy weight, electrolyte imbalance, acetonuria, and ketosis
Hyperemesis gravidarum
What can hyperemesis gravidarum be associated with?
Thyroid function
What risks to the fetus are there if hyperemesis gravidarum persists?
IUGR or preterm birth
What maternal age is a risk factor for hyperemesis gravidarum?
Younger than 20
Other risks: history of migraine, obesity, first preg, multifetal gestation, gestational trophoblastic disease, fetus with chromosomal anomaly, phychosocial issues, high levels of emotional stress, transient hyperthyroidism
Hyperemesis gravidarum: What happens to PR? BP?
PR: Increase
BP: Decrease
Hyperemesis gravidarum: What is the most important initial lab test?
Urinalysis for ketones and acetones (breakdown of protein and fat)
Hyperemesis gravidarum:
- How is urine specific gravity?
- What electrolyte imbalances are there?
- Acidosis or alkalosis?
- How are liver enzymes?
- Urine specific gravity: Elevated
- Electrolyte imbalances: Na, K, and Cl reduced from low intake
- Acidosis from excessive vomiting
- Liver enzymes: Elevated
Hyperemesis gravidarum: Why would Hct concentration be elevated?
Because inability to retain fluid results in hemoconcentration
Nursing care for hyperemesis gravidarum: We would do all things regarding dehydration (monitor I&O, assess skin turgor/MM, monitor VS and weight). The client is also to remain NPO….how long should they be NPO?
24-48 hours
Hyperemesis gravidarum: What meds can we give? (4)
- IV fluids: LR for hydration
- Pyridoxine (Vit B) and other vit supplements as tolerated
- Antimetic meds for uncontrollable NV (ondansetron, metoclopramide)
- Corticostroids: To treat refractory hyperemesis gravidarum
Hyperemesis gravidarum: Discharge instrusctions?
- Clear liquids after 24 hours if no vomiting
- Advance diet as tolerated with frequent, small meals (start with dry toast, crackers or cereal, then move to soft diet, then to normal diet)
- In severe cases, if V returns, enteral nutrition may be considered
Occurs during pregnancy due to inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron
Anemia
What are the lab tests that diagnose anemia?
Hgb less than 11 mg/dL in 1st and 3rd tri
Hgb less than 10.5 mg/dL in 2nd tri
Hot less than 33%
What is prophylactic treatment for anemia?
Using prenatal supplements with 60 mg of iron is suggested