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
What are foods rich in iron?
Legumes
Fruit
Green, leafy vegetables
Meat
What are meds for anemia?
Ferrous sulfate iron 325 mg 2x/d
How should a client be advised to take iron supplements?
- On empty stomach
- Encourage diet rich in Vit. C to increase absorption
- Suggest client increase roughage and fluid in diet to assist with discomforts of constipation
Why would someone take iron dextran instead of oral iron supplements?
Iron dextran is used in treatment for iron-deficiency anemia when oral iron supplements cannot be tolerated by the client who is pregnant
An impaired tolerance to glucose with the first onset of recognition during pregnancy
Gestational diabetes
What is the ideal blood glucose level during pregnancy?
Fall between 70-110 mg/dL
What are some of the risks gestational diabetes can cause to the fetus?
- Spontaneous abortion
- Infections
- Hydraminos
- Ketoacidosis
- Hypoglycemia
- Hyperglycemia
What maternal age is a risk factor for gestational diabetes?
Older than 25
Other risk factors: Family history of diabetes, previous delivery of an infant that was large or stillborn
What are signs of hypoglycemia?
Blurred vision Hunger Headache Irritability Nervousness Tingling of mouth or extremities Weakness
What are signs of hyperglycemia?
- Abdominal pain
- Flushed dry skin
- Frequent urination
- Fruity breath
- Nausea
- Thirst
Describe the glucola screening test/1hr glucose tolerance test.
Client comes in and gets 50 g oral glucose load followed by plasma glucose analysis 1 hour later
- Fasting not necessary
- Preformed 24-28 weeks gestation
- If glucose comes back 130-140 mg/dL or greater, then the 3 hour glucose test would be indicated
Described the 3 hour glucose tolerance test.
Client comes in after fasting overnight. Fasting includes avoiding caffeine and not smoking for 12 hours prior to the test. A fasting glucose is obtained, then 100 g glucose load is given and the glucose levels are taken at 1, 2, and 3 hours following the glucose ingestion
What is the underlying mechanism for the manifestations of pregnancy hypertensive disorders?
Vasospasm contributing to poor perfusion
Gestational hypertension (GH), which begins after the ___ week of pregnancy, describes HTN disorders of pregnancy whereby the woman has an elevated BP at _____ or greater recorded at least twice, 4-6 hours apart, and within a 1 week period. There is no proteinuria. The presence of edema is no longer considered in the definition of HTN disease of pregnancy. The clients BP returns to baseline by 6 weeks postpartum
20th week; 140/90 or greater
Mild preeclampsia is GH with the additions of proteinuria of greater than ____.
What else may be present with mild preeclampsia?
1+
Transient headaches may or may not occur along with episodes of irritability; edema may be present
Severe preeclampsia: BP? Proteinuria? Oliguria or polyuria? Sereum creatinine?
BP: 160/100 or greater
Proteinuria: Greater than 3+
Oliguria
Serum creatinine: Greater than 1.2
Other things with severe: headache, blurred vision, hyperreflexia and possible ankle clonus, pulmonary/cardiac involvement, extensive peripheral edema, hepatic dysfunction, epigastric and RUQ pain, thrombocytopenia
What is eclampsia?
Severe preeclampsia symptoms with onset of seizure activity or coma
What is eclampsia preceded by?
Headache
Severe epigastric pain
Hyperreflexia
Hemoconcentrations
HELLP syndrome is a variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction. HELLP syndrome is diagnosed by lab tests, not clinically. What are those lab tests?
H: Hemolysis resulting in anemia or jaundice
EL: Elevated liver enzymes–> elevated ALT or AST, epigastric pain, and NV
LP: Low platelets (less than 100,000)
What is gestational hypertensive disease associated with?
Placental abruption Kidney function Hepatic rupture Preterm birth Fetal and maternal death
What kind of meds may be given for GH?
- Antihypertensive meds (methyldopa, nifedipine, hydralazine, labetalol hcl, AVOID ACE and ARBs)
- Anticonvulsant meds (magnesium sulfate)
GH: Why is magnesium sulfate the medication of choice for prophylaxis or treatment?
Because it lowers BP and depresses CNS
What are some nursing considerations regarding magnesium sulfate for GH? (3)
- Inform client she may feel flushed, hot, and sedated with the bolus
- Monitor BP, PR, RR, reflexes, LOC, UO, headache/visual disturbances, epigastric pain, contractions, and FHR/activity
- Fluid restrictions of 100-125 mL/hr and maintain UO of 30 mL/hr or greater
What are signs of magnesium sulfate toxicity? (5)
- Absence of patellar deep tendon reflexes
- UO less than 30 mL/hr
- RR less than 12/min
- Decreased LOC
- Cardiac dysrhythmias
What do we do if magnesium sulfate toxicity is suspected?
- Immediately discontinue the infusion
- Administer the antidote: CALCIUM GLUCONATE
- Prepare for actions to prevent respiratory or cardiac arrest!
A nurse is caring for a client at 14 weeks gestation who has hyperemesis gravidarum. The nurse is aware that which of the following are risk factors for the client (SATA)
A. Obesity B. Multifetal pregnancy C. Maternal age greater than 40 D. Migraine headache E. Oligohydraminos
A, B, D
A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicated magnesium sulfate toxicity (SATA)
A. RR fewer than 12/min B. UO less than 30 mL/hr C. Hyperreflexic deep-tendon reflexes D. Decreased LOC E. Flushing and sweating
A, B, D
A nurse is caring for a client who is receiving IV mag. sulfate. Which of the following meds should the nurse anticipate administering if mag. sulfate toxicity is suspected?
A. Nifedipine
B. Pyridoxine
C. Ferrous sulfate
D. Calcium gluconate
D
A nurse is reviewing a new prescription for ferrous sulfate with a client who is at 12 weeks gestation. Which of the following statements by the client indicates understanding of the teaching?
A. I will take this pill with my breakfast
B. I will take this medication with a glass of milk
C. I plan to drink more OJ while taking this pill
D. I plan to add more calcium rich foods to my diet while taking this med
C
A nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing the client’s lab reports. Which of the following findings is a clinical manifestation of this condition?
A. Hgb 12.2 g/dL
B. Urine ketones present
C. ALT 20 IU/L
D. Serum glucose 114 mg/dL
B
