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NU 330 > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

what are some gestational complications?

A
  • premature labor/birth
  • premature rupture of membranes/ chorioamniotis
  • cervical insufficiency
  • multiple gestation
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2
Q

preterm labor can be described as __, __ or __

A
  • extremely preterm: <28 weeks
  • very preterm: 28-32 weeks
  • moderate-late preterm: 32-37 weeks
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3
Q

major factors that affect/cause preterm labor

A
  • uterine stretching
  • decidual activation
  • intrauterine infection
  • maternal or fetal stress
  • hx of preterm labor/birth
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4
Q

preterm birth: viability

A

more than likely, the fetus will survive outside the womb

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5
Q

preterm birth: peri variability

A

more than likely, the fetus will not survive outside the womb

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6
Q

risk factors of preterm birth

A
  • prior preterm birth
  • multiple gestation (not enough room for 2+)
  • uterine/cervical abnormalities
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7
Q

management of PTL/PTB

A
  • prediction: transvaginal ultrasound, fetal fibronectin
  • medical: non-pharmacological, pharmacological
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8
Q

common medications for PTL

A
  • calcium channel blocker: Nifedipine
  • NSAID: indomethacin
  • magnesium sulfate
  • beta-adrengic receptor agonist: terbutaline
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9
Q

Nifedipine

A

calcium channel blocker used to treat PTL/PTB
- BP med
- 30 mg loading dose q4-6 hours
- <100 systolic BP: do not give

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10
Q

Terbutaline

A

beta-adrengic recepetor agonist used to treat PTL/PTB
smooth muscle relaxer; asthmatic drug
- causes maternal & fetal tachycardia
- monitor strict I&O, listen to lung sounds regularly
- risk for pulmonary edema, crackles in lungs, respiratory distress- cardiac arrest
- 0.5 mg dose

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11
Q

Indomethacin

A

NSAID used to treat PTL/PTB
- blocks the inflammatory response that triggers labor
- 100 mg rectally loading dose q1-2 hours if contractions persist
- 25 mg orally for next 24 hours

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12
Q

Magnesium Sulfate

A

used to treat
- PTL/PTB
- preeclampsia
- smooth muscle relaxant; use for fetal neural protection and to prevent seizures for mom
- causes lethargy, N/V, HA, resp. depression
- 4-8 mg is the therapeutic dose

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13
Q

maternal risk of PTL/PTB

A
  • cardiac arrhythmias
  • pulmonary edema
  • CHF
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14
Q

fetus-newborn risk of PTL/PTB

A

premature

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15
Q

contraindications to preventing/treating PTL/PTB

A
  • intrauterine fetal demise
  • lethal fetal anomaly
  • severe preeclampsia
  • non-reassuring fetal status
  • chorioamnionitis
  • premature rupture of membranes
  • maternal contraindications to tocolytics
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16
Q

nurse actions for patient at risk for PTL/PTB

A

-prenatal
- s/sx of PTL
- assess FHR
- cultures
- change position
- administer medication
- I&O
- FFN
- cervical status
- lung assessment
- notify provider
- emotional support
- education: fever, backache, water breaks, bleeding, more than 5-6 contractions in 1 hr, increased vaginal d/c- call doctor
- labs

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17
Q

what are the two types of premature ruptures?

A
  • premature rupture of membranes (PROM); membranes rupture is anytime after 37 weeks (but before labor/not associated with labor)
  • preterm premature rupture of membranes (PPROM): membranes rupture before 37 weeks
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18
Q

risk factors for PROM/PPROM

A
  • STI
  • multiple gestation
  • hydramnios
  • short cervical length
  • bleeding
  • previous PPROM or preterm birth
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19
Q

management of PROM/PPROM before 32 weeks:

A

neuroprotection: mag-sulfate

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20
Q

management of PROM/PPROM before 34 weeks:

A
  • reduce risk for infection
  • administer corticosteroids: betamethasone- stimulates the production of surfactant in fetal lungs; 12 mg IM q24 hours x2: give 1 shot, wait 24 hours then give 2nd shot. (can give “rescue dose” if mom comes back at least 7 days later and still experiencing symptoms)
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21
Q

management of PROM/PPROM after 34 weeks:

A
  • induce labor
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22
Q

nursing actions for PROM/PPROM

A
  • assess FHR and contractions
  • assess for signs of infection
  • monitor for labor signs: NST, BPP
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23
Q

cervical insufficiency

A
  • want cervix to be 30-50 mm thick
  • <25 mm is insufficient/ shortened cervix
  • painless cervical dilation: after 1st trimester
  • expulsion of pregnancy: in 2nd trimester
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24
Q

causes of cervical insufficiency

A
  • previous cervical trauma
  • D & C (abortion)
  • cervical lacerations, LEEP
  • abnormal cervical development
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25
Q

risks of cervical insufficiency

A
  • hx of 2nd and early 3rd trimester births
  • complications of cerclage: ROM, chorioamnionitis, cervical lacerations
  • fetal risks: preterm birth
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26
Q

management of cervical insufficiency

A
  • nonsurgical: activity rest, pessary, cervical cultures, antibiotics/tocolytics, serial transvaginal ultrasound
  • surgical: cerclage, removal
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27
Q

nursing actions: post-cerclage

A
  • monitor uterine activity
  • monitor for vaginal bleeding/leaking of fluids
  • monitor for infections
  • discharge teaching: infection s/sx: fever, ROM, bleeding
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28
Q

multiple gestation: meaning

A

carrying multiple fetus’
- monozygotic twins
- dizygotic twins

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29
Q

monochorionic/monoamniotic twins

A

monozygotic twins that share a chorionic sac and placenta

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30
Q

monochorionic/diamniotic twins

A

monozygotic twins that have one chorionic sac but separate placentas fused together

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31
Q

dichorionic/diamniotic twins

A
  • monozygotic twins that have two chorion and separate placentas fused together
  • dizygotic twins that have two chorion and separate placentas
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32
Q

twin type: morula splits

A

dichorionic diamniotic twins
- two separate placentas
- identical/monozygotic

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33
Q

twin type: split at hatching

A

monochorionic diamniotic
- fused placenta
- identical/monozygotic

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34
Q

twin type: blastocyst splits up to 1 week after implantation

A

monochorionic monoamniotic
- one placenta
- identical/monozygotic

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35
Q

twin type: two eggs/fertilzations

A

dichorionic diamniotic
- separate placentas
- fraternal/dizygotic

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36
Q

risks for women with multiple gestation

A
  • hypertensive disorders
  • gestational diabetes
  • maternal hemorrhage
  • anemia
  • cholestasis
  • acute fatty liver
  • cesarean birth
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37
Q

risks for fetus-newborns of multiple gestation

A
  • increase fetal morbidity and morality
  • preterm birth
  • increased risk of LBW
  • monochorionic twins
  • IUGR
  • increased risk of congenital, chromosomal, genetic defects
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38
Q

maternal physiological changes for multiple gestation

A
  • physiological changes are greater in twin pregnancies
  • HCG levels increased
  • fundal height is greater than dates
  • increased cardiac output
  • maternal blood volume is > 50-60%
  • increased plasma volume
  • increased dermatosis
  • increased iron deficiency anemia
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39
Q

multiple gestation: ultrasound assessment shows __

A
  • gestational age
  • growth restriction
  • chronioncity/amnionicity
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40
Q

management of multiple gestation

A
  • ultrasound
  • genetic testings
  • monitor signs of PTB (*high risk for PTB)
  • monitor for maternal anemia
  • NST/BPP
  • monitor for hypertension/preeclampsia
  • monitor for hydramnios
  • consult with perinatologist (NICU providers) when needed
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41
Q

nursing actions for multiple gestation

A
  • assess for complications
  • NST/BPP
  • education
  • nutrition
  • emotional support
  • adaptation of the couple
  • referrals as needed
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42
Q

Hyperemesis Gravidarum is __

A

N/V
- peaks at 9 weeks gestation
- subsides around 20 weeks

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43
Q

hyperemesis gravidarum leads to __

A
  • dehydration
  • electrolyte and acid-base imbalance
  • starvation ketosis
  • weight loss
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44
Q

management of hyperemesis gravidarum

A
  • treatment of N/V
  • hydration (IV- banana bag- vit B, vitamins, minerals)
  • labs
  • correction of ketosis and vitamin deficiency
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45
Q

nursing actions for hyperemesis gravidarum

A
  • assess N/V
  • treatment of N/V
  • emotional support
  • oral hygiene
  • daily weight
  • I&O
  • labs
  • education
  • complimentary therapy
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46
Q

intrahepatic cholestasis (ICP)

A
  • pruritis (itchy) of the palms and soles of the feet
  • hormonal
  • develops late in pregnancy
  • people are genetically predisposed
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47
Q

intrahepatic cholestasis is associated with what?

A
  • increased preterm delivery
  • meconium passage
  • FHR abnormalities
  • fetal death (IUFD)
48
Q

intrahepatic cholestasis: risks to fetus

A
  • serum bile acid levels
  • transaminase levels
49
Q

management of intrahepatic cholestasis

A
  • UCDA: ursodeoxycholic acid
  • antihistamines, corticosteroids, cholesytrmine
  • risks to fetus
  • NST/BPP
  • delivery at 36 weeks
50
Q

nursing actions for intrahepatic cholestasis

A
  • monitor labs
  • aquenous cream
  • administer medications
  • education
51
Q

deiabetes mellitus: types

A
  • pregestational: type 1 or type 2
  • in pregnancy: gestational
52
Q

normal changes in pregnancy when mom has diabetes

A
  • insulin resistance
  • hormonal shifts
53
Q

goals for diabetic mom during pregnancy

A
  • maintain euglycemia (normal glucose) control
  • minimize complications
  • prevent prematurity
54
Q

pregestational diabetes: risks to mom

A
  • DKA: diabetic ketoacidosis (very high blood sugar)
  • hypertension/preeclampsia
  • preterm labor
  • spontaneous abortion
  • poly/oligohydramnios
  • cesarean section
  • infection
  • postpartum hemorrhage
55
Q

pregestational diabetes: risks to fetus/newborn

A
  • congenital defects
  • macrosomia: abn large for gest. age
  • hypoglycemia
  • IUGR: abn. small for gest. age
  • respiratory distress
  • polycythemia
  • prematurity
  • cardiomyopathy
  • stillbirth
56
Q

medical managment of pregestational diabetes

A
  • preconception care is the key in decreasing risks to both mom and baby
  • HbA1C: may require more insulin than usual near end of pregnancy to maintain (3x as much sometimes)
  • screening of kidney, thyroid, heart, eyes
  • ultrasound, prenatal care, and antenatal testing
  • medical nutrition therapy
57
Q

risks during delivery: pregestational diabetes

A
  • TTN: transient tachypnea: delay in clearance of fetal lung fluid following delivery
  • respiratory distress: follows TTN
  • hypoglycemia: follows resp. distress
58
Q

nursing actions: pregestational diabetes

A
  • educate
  • nutrition: adjust meals/timing
  • record keeping
  • NST/BPP
59
Q

gestational diabetes (GDM) testing

A
  • screening from 24-28 weeks
  • 1 hr glucose tolerance test (50g)
  • 3 hr glucose tolerance test (100g)
60
Q

risks for women with gestational diabetes

A
  • hypoglycemia and DKA
  • preeclampsia
  • cesarean birth
  • development of non-gestational diabetes
61
Q

gestational diabetes: risks to fetus/newborn

A
  • macrosomia
  • IUGR
  • hypoglycemia
  • hyperbilirubinemia
  • shoulder dystocia
  • respiratory distress
  • birth trauma (because they are so big)
62
Q

medical management: gestational diabetes

A
  • controlled with diet and exercise
  • 40% controlled by insulin
  • cesarean section for fetus >4500g
  • monitor for type 2 diabetes following pregnancy
63
Q

nursing actions: gestational diabetes

A
  • education
  • diet management
  • reinforce self-care/self-management
64
Q

preeclampsia

A
  • a disease involving the development or worsening of high blood pressure; typically during 2nd trimester
  • systolic is 140 or higher
  • unknown etiology
  • HTN after 20 weeks gestation
  • proteinuria
  • treatment is symptomatic
65
Q

risk factors that cause preeclampsia

A
  • nulliparity
  • <20 years old
  • > 35 years old
  • multiple gestation
  • previous family hx
  • chronic HTN
  • gestational diabetes
66
Q

preeclampsia: risks to women

A
  • cerebral edema/hemorrhage, stroke
  • pulmonary edema
  • DIC: decimated intravascular coagulation
  • CHF: congestive heart failure
  • HELLP
  • abruption
  • risk of developing heart disease
67
Q

eclampsia

A
  • a severe form of preeclampsia
  • same s/sx as preeclampsia, & seizures
68
Q

HELLP syndrome

A

Hemolysis
Elevated
Liver enzymes
Low
Platelets

  • considered to be a variant of preeclampsia/ complication of preeclampsia
    ** only treatment is to deliver infant and placenta
69
Q

preeclampsia: risks to fetus

A
  • IUGR
  • premature
  • stillbirth
  • intolerance to labor
70
Q

preeclampsia s/sx

A
  • elevated BP
  • proteinuria
  • elevated liver function tests
  • headache
  • visual changes
  • epigastric pain
71
Q

s/sx of (mild) preeclampsia

A
  • elevated BP
  • protein in urine
  • water retention and swelling
  • weight gain exceeding 2lbs/week
72
Q

s/sx of severe preeclampsia

A
  • headaches
  • changes in vision
  • pain in abdomen and back
  • nausea/vomiting
73
Q

medical management of preeclampsia

A
  • magnesium sulfate
  • antihypertensive medications
  • induction of labor
74
Q

warning signs of eclampsia

A
  • severe HA
  • epigastric pain
  • hyperreflexia with clonus (tremors)
  • restlessness
75
Q

eclampsia: during seizure care

A
  • remain with patient
  • call for assistance
  • prevent injury
  • document
76
Q

eclampsia: post seizure care

A
  • assess maternal fetal status
  • assess airway
  • administer oxygen
  • IV access
  • administer magnesium
77
Q

nursing actions: eclampsia/preeclampsia

A
  • assess for signs of preeclampsia
  • monitor labs
  • administer medications
  • test urine (looking for protein in urine)
78
Q

hemolysis

A

red blood cells are broken down too quickly
- can lead to anemia

79
Q

elevated liver enzymes

A
  • taken as a sign that liver function is compromised
80
Q

low platelet count

A

at risk for excessive bleeding because platelets are responsible for clotting blood
- low platelet because they are gathering at site of damage

81
Q

hypertensive disorders of pregnancy

A
  • chronic hypertension
  • preeclampsia
  • eclampsia
  • gestational hypertension
82
Q

4 R’s of quality improvement AIM patient safety bundle: severe hypertension

A

Readiness
- every unit: preparations, education, simulations
Recognition & Prevention
- every patient: screening, dx and classification, prevention approaches
Response
- every event/case: management and treatment, patient education
Reporting & Systems Learning
- every unit: debriefs & multidisciplinary review, QI measures, documentation and coding

83
Q

placenta previa: risk factors

A
  • endometrial scarring and increased placental mass
  • maternal: shock, blood loss, Rh sensitization, maternal death
  • feus/newborn: fetal compromise, hypoxia, fetal anemia, prematurity
84
Q

placenta previa: s/sx

A
  • painless vaginal bleeding (bright red)
  • hemodynamic changes related to blood loss
  • FHR changes due to maternal blood loss
85
Q

management of placenta previa

A
  • ultrasound placenta location
  • cesarean section
  • monitor bleeding
86
Q

nursing actions: placenta previa

A
  • monitor labs
  • assessment: color and amount of blood
  • notify provider
  • assess for pain, contractions
  • IV insertion/maintenance
  • administer medication
87
Q

placenta abruption

A
  • bleeding at the decidual-placenta interface which can result in partial or complete detachment of the placenta before delivery
  • bleeding is always maternal
88
Q

placenta abruption: s/sx

A
  • vaginal bleeding
  • abdominal pain
  • hypertonic contractions
  • uterine tenderness
  • non-reassuring FHR
89
Q

placenta abruption: risk factors

A
  • previous abruption
  • hypertensive disorders
  • trauma
  • maternal: blood loss, hysterectomy, renal failure, maternal death
  • fetus/newborn: premature, asphyxia, stillbirth, perinatal death
90
Q

medical management of placenta abruption

A
  • hospitalization
  • steroids: betamethasone sodium phosphate
91
Q

nursing actions: placenta abruption

A
  • FHR monitoring
  • s/sx of abruption
  • palpate uterus (tender- not good)
  • monitor for hypotension
  • insertion of IV
  • oxygen
  • document blood loss
92
Q

placenta accreta: risks

A
  • maternal: hemorrhage, shock, excessive blood loss, infection, thromboembolism, surgical complication
  • fetus/newborn: premature
93
Q

placenta increta

A

placenta attaches itself deep into the myometrium of the uterus muscle wall.

94
Q

placenta percreta

A

placenta attaches itself and grows through uterine wall and extends into other organs, i.e. bladder
- need to deliver baby

95
Q

medical management: placenta accreta

A
  • timing of delivery
  • potential need for hysterectomy
96
Q

nursing actions: placenta accreta

A
  • assess
  • education
  • emotional support
  • monitor labs: CBC, clotting factors
97
Q

ectopic pregnancy

A
  • implantation outside of uterus, in fallopian tube
  • 95% occur in fallopian tube
98
Q

ectopic pregnancy: s/sx

A
  • pelvic pain: sharp, sudden onset, lower
  • light to heavy bleeding
  • weakness, dizziness
99
Q

management of ectopic pregnancy

A
  • early dx: HCG levels, transvaginal ultrasound, progesterone levels
  • medication if tube not ruptured (not a viable pregnancy)- Methotrexate
100
Q

gestational trophoblastic disease

A
  • abnormal trophoblast cells grow inside the uterus
  • non-viable pregnancy
  • will have hCG, will feel like pregnancy but ultrasound will show abnormal cells and not a fetus
  • molar: hydatiform mole; 3rd haploid genome is paternally derived
  • non-molar: gestational trophoblastic neoplasia; 3rd haploid genome is maternally derived
101
Q

TORCH infections: define

A

Toxoplasmosis
Other- Hep B
Rubella
Cytomegalovirus
Herpes simplex

102
Q

substance abuse affects on fetus/newborn

A
  • LBW
  • developmental disabilities
  • preterm birth
  • infant mortality
102
Q

what is substance abuse?

A
  • alcohol
  • smoking
  • illicit drugs: cocaine, opioid use, marijuana
103
Q

facial characteristics associated with fetal alcohol exposure

A
  • low nasal bridge
  • minor ear abnormalities
  • indinstint philtrum
  • micrognathia
  • thin upper lip
  • flat midface and short nose
  • short palpebral fissures
  • epicanthal folds
104
Q

decidual activation

A

the cells talk to each other and all decide to go into labor

105
Q

fetal fibronectin

A

in lining of the uterus and amniotic sac normally
- swab the vaginal canal (present)- increased risk of delivering in the next 7 days
- swab the vaginal canal (not present)- likely you won’t go into labor soon

106
Q

calcium gluconate

A
  • used to reverse magnesium toxicity
107
Q

cerclage

A

stitch in the cervix closing the opening of the cervix, and putting a rubber band called a pessary to keep it closed
- take out around 36-37 weeks

108
Q

ICP maternal s/sx

A
  • dark urine
  • pale stools
109
Q

diabetes: timing

A

after 20 weeks- gestational
before 20 weeks- diabetic, not gestational diabetic

110
Q

what percent of women with GDM develop Type 2 DM?

A

50%

111
Q

preeclampsia vs. chronic hypertension

A

preeclampsia: HTN that develops after 20 weeks gestation
chronic HTN: HTN that woman has had all along

112
Q

magnesium sulfate doses

A
  • loading dose 4-8g diluted in 100 mL, over 15-20 minutes (1x)
  • maintenance dose 1-2g q1hr
113
Q

placenta previa is ___

A

when the blood vessels of the placenta are right over the cervix and fetus is resting on top of it

114
Q

placenta accreta is __

A

when the placenta grows into the uterine wall during pregnancy; placenta remains attached after birth of child

115
Q

nursing actions: gestational trophoblastic disease

A
  • D&C
  • monitor hCG levels: want normal for 6 months before tries to get pregnant again
116
Q

management of hypertensive disorders in pregnancy (HDP): 5 key elements

A
  1. recognize sx and dx HDP
  2. blood pressure control
  3. seizure prevention
  4. delivery
    - 34 weeks: preeclampsia with severe features
    - 37 weeks: preeclampsia without severe features or gestational hypertension
  5. postpartum surveillance

NU 330 (18 decks)

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