Chapter 12. Nursing Management During Nursing Flashcards
Isotretinoins/accutane
Used to treat acne. Can result in miscarriage and birth defects.
Alcohol misuse
Feel alcohol syndrome and other birth defects. Should cease intake before conception
Antiepileptic drugs
Women who are on these drugs should be prescribed a lower dose before conception.
Diabetes preconception
There’s a threefold increase in birth defects among infants of women with type I and type II diabetes. This is reduced if Properly managed
Folic acid deficiency
A supplement at least 400 mcg reduces the occurrence of neural tube defects by two thirds
Hepatitis B
Preventing infection and women of childbearing age prevents transmission to the infants and eliminates the risk to the woman. This could include hepatic failure, liver carcinoma, cirrhosis, and death.
HIV/AIDS
If known before conception, antiretrovirals treatment can be given along with information that can help prevent mother to child transmission.
Hypothyroidism
The dosages of levothyroxine for treatment increase during early pregnancy. It needs to be adjusted for proper neurological development of the fetus.
PKU/maternal phenylketonuria
Women diagnosed with PKU as infants have increased risk for delivery neonates with intellectual disability. This can be prevented when mothers adhere to a low phenylalanine diet before conception and continuing throughout the pregnancy
Rubella seronegativity
Rubella vaccination helps prevent congenital rubella syndrome
Period of greatest risk to embryo
Between day 17 and 56 after conception.
Obesity
Neural tube defects, preterm delivery, diabetes, c-section, hypertensive and thromboembolic disease. Weight-loss and nutritional intake before pregnancy reduces these risks
Oral anticoagulant
Warfarin is teratogen. They should be changed to a different anticoagulant before pregnant
STIs
Chlamydia and gonorrhea are associated with ectopic pregnancy, infertility, chronic pelvic pain. They could result in fetal death or substantial physical and developmental disabilities, including intellectual disability and blindness. Women’s be screened early
Smoking
Preterm birth, low birth weight, and other adverse outcomes is associated with smoking. They can be prevented if they stop smoking before or during early pregnancy.
Diabetes testing
Should be tested at the first prenatal visit if high risk which includes women over 25, overweight, have polycystic ovarian syndrome, history of gestational diabetes, and a positive history of family diabetes. High risk populations include Hispanic, black, Asian, Arab, Afro Caribbean, Mediterranean, and native American.
Fasting plasma glucose 126 mg/dL
Hemoglobin A-1C at least 6.5%
Random plasma glucose 200 mg/dL
Normally tested from 24 to 28 weeks
Nageles rule
Subtract three months from the first day of her last menstrual period and then add seven days.
Margin of error is plus or -2 weeks
Less accurate if the cycles are irregular, if the woman conceived while breast-feeding, before her regular cycle is established after childbirth, or after discontinuing oral contraceptives
Ultrasound is the most accurate method of dating a pregnancy
Gravid
The state of being pregnant
Gravida
A pregnant woman. Gravidarum I/primigravida is the first pregnancy, gravida II/secundigravida is the second pregnancy. Nulligravida never pregnant. Multigravida pregnant at least third time
Para
The number of deliveries at 20 weeks or greater that a Woman has, regardless of whether it was born alive or dead.
Nullipara never offspring after 20 weeks
Multipara a woman 2 or more
Gravidity
The number of times that a woman has been pregnant, irrespective of the outcome
GTPAL
G-gravida, including current pregnancy T-term gestations 38-42 P-preterm 20-37 A-#ending before 20 weeks L-children currently living
If an extra p, it is the same as L
Appointment schedule
Every four weeks up to 28 weeks
Every two weeks from 29 to 36 weeks
Every week from 37 weeks to birth
Weight and blood pressure compared to the baseline. Urine testing for protein, glucose, ketones, and nitrates. Fundal height to assess fetal growth. Assessment for quickening/fetal movement. Assessment of fetal heart rate.
Fundal height measurement
From the top of the pubic bone to the top of the uterus/fundus with the client lying on her back and knees slightly flexed. This is termed McDonald’s method.
Fetal movements
While sitting or lying record mmovvements. Notified Dr. if there’s not at least 10 within one hour. This needs to be done around the same time everyday
The second option is to lie on the left side for one hour after meals, Count how many movements she felt in one hour, needs to be at least 4, if not wait one more hour to see if you can feel 4 more movements
Danger during the first trimester
Spotting or bleeding, painful urination, persistent vomiting, fever abovve100, lower abdominal pain with dizziness and shoulder pain, which could indicate ruptured ectopic pregnancy
Danger during the second trimester
Regular contractions, pain in calf, rupture of membranes, absence of fetal movement for more than 12 hours.
Dangers during the third trimester
sudden weight gain, periorbital or facial edema, severe abdominal pain, headache with visual changes, decreases in fetal movement, any of the other warning signs
Preterm labor
If experiencing cramps occurring every 10 minutes accompanied by a low backache, just stop what she is doing and lie down on her left side for one hour and drink 2 to 3 glasses of water. If they do not stop she needs to go into the doctor
Amniocentesis
Detects chromosomal abnormalities and hereditary metabolic defects in the fetus. Performed in the second trimester, usually between 15 and 18.
While under ultrasound a 5 inch needle is inserted to withdraw fluid. Empty bladder prior to procedure. Fetal heart rate monitoring is done for 20 minutes. RhoGAM maybe given if the woman is Rh negative. Assess maternal vital signs and fetal heart rate every 15 minutes for an hour. Observe for bleeding and drainage. Report fever, leaking fluid, vaginal bleeding, uterine contractions, or change in fetal activity.
chorionic villus sampling
Detect chromosomal disorders, enzyme deficiency, fetal gender determination, and sex linked disorders such as hemophilia, sickle cell anemia, and Taysachs disease. 10 to 13 weeks after the last menstrual period. The ultrasound confirms gestational age, and then under ultrasound guidance transcervical or transabdominal is done. The client must have a full bladder. RhoGAM is given to Rh negative women. Report fever, cramping, vaginal bleeding, no strenuous activity for 48 hours.
Nonstress test
Recommended twice-weekly after 28 weeks for clients with diabetes and preeclampsia, postterm pregnancy, renal disease, and multi fetal pregnancy. It is to determine fetal heart rate patterns in response to movement. The mother eats a meal, lays in the left lateral position, monitoring devices are placed, the client is given a button to push every time she feels feel movement. That marks the fetal monitor strip. Usually lasts 20 to 30 minutes. a reactive test includes two accelerations of at least 15 beats for at least 15 seconds with in the 20 minute period. If it does not meet this after 40 minutes it is considered nonreactive.
Vaccinations to get
Hepatitis B, influenza, tetanus/diphtheria., Meningococcal, Rabies
Vaccinations to avoid
Live influenza, measles, mumps, rubella, varicella, tuberculosis, typhoid
