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PNC 102 lecture > Chapter 8 nursing care of woman w/ pregnancy complications > Flashcards

Chapter 8 nursing care of woman w/ pregnancy complications Flashcards

1
Q

hyperemesis gravidarum

A

is a more severe form of morning sickness persisting past 20 weeks’ gestation

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2
Q

hyperemesis gravidarum may cause…

A

dehydration, electrolyte, and acid base imbalances, nutritional deficiencies, and even death

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3
Q

women suffering from hyperemesis gravidarum in the second trimester have increased risk for…

A

preterm labor
preeclapsia
protein in the urine
edema
placental abruption

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4
Q

during hyperemesis gravidarum, fetus may have…

A

poor placental perfusion and oxygenation that may lead to a small for gestation age (SGA) infant

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5
Q

incidence and risk factors of hyperemesis gravidarum

A
  • 0.3%-2% of all pregnancies
  • elevated hcg and free T4 levels
  • degree of thyroid stimulation
  • elevated estradiol levels
  • previous intolerance to oral contraceptives
  • relaxation of smooth muscle causing delayed gastric emptying
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6
Q

signs and symptoms of hyperemesis gravidarum

A
  • vomiting multiple times throughout the day
  • poor appetite
  • weight loss (>5% of pre pregnancy weight)
  • dehydration: signs and symptoms - dry mouth, poor skin turgor, concentrated urine, decreased urine output, elevated heart rate, alkalosis from loss of hydrochloric acid
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7
Q

medical care for hyperemesis gravidarum

A

medical care: acupuncture and acupressure for women who want to avoid the use of medications in the first trimester of pregnancy
- initial management: vitamin b6 10-25mg TID, doxylamine 12.5mg TID or QID, Ginger capsules 250mg QID

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8
Q

medications used for severe cases

A
  • metoclopramide 5-0mg q8h
  • promethazine 12.5 mg oral or rectal q4h
  • dimenhydrinate 50-100mg q4-6h
  • ondansetron 4-8 mg oral or IV q8h
  • severe cases may also warrant investigation for other possible causes such as gastroenteritis, pancreatitis, hepatitis, ulcers, and kidney disorders
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9
Q

lab studies may be ordered to monitor pts health status with hyperemesis gravidarum

A

CBC
electrolytes
Ketones
liver enzymes

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10
Q

nursing care for hyperemesis gravidarum

A
  • administer IV fluids and antiemetics
  • monitor lab results and report abnormalities
  • monitor for weight loss
  • meet psychosocial needs
  • refer to appropriate resources
  • allow time to listen to pts concerns
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11
Q

patient teaching with hypermesis gravidarum

A

eat small, frequent meals and avoid spicy, fatty foods
- avoid odors or foods that may trigger nausea
- maintain fluid intake to avoid dehydration
- monitor for signs of dehydration

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12
Q

notify provider of warning signs with hyperemesis gravidarum

A

dark urine
bloody vomit
abdominal pain
dehydration
lack of urine output for 8 hours
dehydration
lack of urine output for 8 hours
inability to keep food down for 24 hours
ketones in the urine

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13
Q

care of the woman with bleeding disorders of early pregnancy

A
  • bleeding during pregnancy is always abnormal, especially in the first trimester because it threatens the viability of pregnancy
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14
Q

bleeding disorders of early pregnancy

A

spontaneous abortion
ectopic pregnancy
gestational trophoblastic disease (GTD)

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15
Q

abortion

A

a pregnancy loss or termination

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16
Q

viable

A

refers to the fetus that is able to live outside the uterus with age greater than 20 weeks of gestation, or weight greater than 500 g

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17
Q

incidence and risk factors

A
  • spontaneous abortion (miscarriage) is the most common type, occurring in up to 2% of all clinically recognized pregnancies
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18
Q

possible causes of abortion include

A
  • fetal chromosomal abnormalities
  • uncontrolled diabetes
  • hypothyroidism
  • maternal infection
  • reproductive abnormalities, or maternal injury
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19
Q

classification of spontaneous abortion according to symptoms and the outcome

A
  • threatened abortions
  • inevitable abortions
  • incomplete abortions
  • complete abortions
  • missed abortions
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20
Q

signs and symptoms of spontaneous abortion

A
  • lower abdominal cramping
  • vaginal bleeding
  • these symptoms can also occur with other early pregnancy complications; thorough examination and testing must be done prior to treatment
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21
Q

medical care for spontaneous abortion

A
  • if it’s complete, usually does not require additional treatment
  • if bleeding does not stop, may need dilation and curettage, vacuum extraction, vacuum d&c
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22
Q

dilation and curettage (D&C)

A

surgical procedure in which the cervix is dilated and the physician gently scrapes the lining of the uterus to remove the products of conception
- risks include bleeding, infection, and possible uterine perforation

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23
Q

an alternative to D&C is medication therapy which can be considered in women without…

A

infection, hemorrhage, severe anemia, or bleeding disorders
=- mifepristone
- misoprostol
- pain medication
- passage of tissues should occur within a few days after medication therapy. If unsuccessful, surgical approach may follow
- risks include bleeding, infection, possible incomplete abortion, and possible failure of medication therapy

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24
Q

nursing care for abortion

A
  • monitor vital signs, I&Os, 02, and lab test results
  • monitor for hypovolemic shock
  • anticipate IV fluids and oxygen therapy
  • administer medications as ordered to control bleeding (oxytocin or methylergonovine)
  • possible alerting the lab to blood type and crossmatch the pt for possible blood transfusion
  • administer RhD immune globulin (RhoGAM) to rh-negative woman within 72 hours to prevent isoimmunization
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25
Q

patient teaching for a planned, spontaneous, or elective abortion

A
  • warning signs of complications after a d&c or administrati of misoprostol
  • heavy bright red bleeding
  • foul smelling vaginal discharge
  • fever
  • pelvic pain
  • do n ot resume sexual activity or use of tampons or douches until advised by the hcp
  • if significant blood loss, take iron supplements w/ orange juice between meals for maximum absorption
  • add liver, green leafy vegetables, and eggs to diet to increase dietary iron
  • discuss when to attempt another pregnancy with her provider
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26
Q

elective abortin

A
  • performed when a woman chooses to terminate a pregnancy
  • medical approach in early pregnancy
  • surgical approach if medical approach is not successful or if pregnancy is more advanced
  • medical care, nursing care, and pt teaching will be similar to other types of abortion
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27
Q

ectopic pregnancy

A

occurs when the fertilized ovum implants outside the uterus, usually in thefallopian tubes, but can occur anywhere outside the uterus; can be life threatening to the woman and may require surgical treatment

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28
Q

incidence and risk factors of ectopic pregnancy

A
  • occurs in 1/50 pregnancies
  • may be caused by scarring of the fallopian tubes or blocks in the tubes
  • advanced maternal age
  • reproductive anomalies
  • history of fllopian tube surgery
  • history of PID
  • repeated induced abortions
  • repeated STIs
  • use of IUDs
  • history of assisted reproductive technology
  • regular douching
  • smoking
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29
Q

signs and symptoms of ectopic pregnancy

A
  • vaginal bleeding and abdominal pain
  • if the fallopian tube ruptures, the following may occur:
  • severe abdominal pain
  • shoulder or neck pain
  • weakness
  • dizziness
  • decreased BP
  • increased heart rate
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30
Q

medical care for ectopic pregnancy

A
  • methotrexate may be administered if the fallopian tube has not ruptured
  • if fallopian tube has ruptured, laparoscopic surgery is performed to save the tube
  • if fallopian tube cannot be saved or pt no longer desires future pregnancy, tube may be removed
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31
Q

salpingstomy

A

small linear incision made into the fallopian tube to remove the products of conception; tube heals w/out suture

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32
Q

salpingctomy

A

surgical removal of the fallopian tube

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33
Q

gestational trophoblastic disease

A

includes several disease processes involving rare tumors that begin in the uterus during placental development

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34
Q

hydatidiform mole (molar pregnancy)

A

rare type of tumor that occurs during very early placental attachment and embryonic development wherein trophoblast cells develop abnormally and cause a placenta to grow and develop, but not the fetus; most common and occurs at the extremes of reproductive years (early teen sor perimenopause)

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35
Q

molar pregnancy classification

A

complete molar
partial molar

36
Q

gestational trophoblastic disease incidence and risk factors

A
  • hydatidiform pregnancies occur in 1 out of 1200 pregnancies in the US and Europe
  • women of Asian descent, of advanced maternal age, or with previous molar pregnancy are at increased risk
37
Q

signs and symptoms of gestational trophoblastic disease

A
  • light to heavy bleeding with brown or bright red blood
  • uterine growth that is larger than expected for gestational age
  • absent fe3tal heart tones aned movement
  • extremely elevated serum hcG levels
  • hyperemesis
  • gestational hypertension
38
Q

medical care for molar pregnancy

A
  • preferred method: suction evacuation and surgical curettage
  • administer IV oxytocin after the procedure
  • monitor for choriocarinoma: a fast growing cancer that can develop in the uterus after a molar pregnancy
39
Q

perfusion

A

blood circulating through the body and oxygenating the tissues
- bleeding in late pregnancy usually indicates placentaattachment problems, causing insufficient oxygenation and nourishment to the fetus; may cause maternal hemorrhage and possible fetal loss

40
Q

bleeding disorders of late pregnancy include

A
  • placenta previa
  • placenta abruptio
  • placenta accreta
41
Q

placenta previa

A
  • low implanted placenta near the opening of the cervix
  • bleeding occurs due to the placenta detaching from the uterus
  • different forms of placenta previa: marginal, partial, complete
42
Q

risk factors of placenta previa

A
  • previous cesarean delivery
  • cocaine use and smoking
  • previous placenta previa
  • uterine scarring from endometriosis
  • previous spontaneous abortion
  • short pregnancy interval
  • previous uterine surgery
  • previous or recurrent abortions
  • non white ethnicity
43
Q

*** signs and symptoms of placenta previa (will be on test)

A
  • PAINLESS, bright red bleeding
  • spotting throughout the second and third trimesters
  • painless hemorrhaging in late pregnancy or when labor begins
44
Q

medical care for placenta previa

A
  • transabdominal or vaginal ultrasound for diagnosis
  • avoid vaginal cervical examination
  • management depends on the type of placenta previa, fetal gestational age, the amount of bleeding, and fetal status
  • bedrest
  • avoid exercise, sexual intercouse, and douching
  • onstress tests to evaluate fetal status
  • cesarean delivery for complete placenta previa and other types depending on the exact locationand the amount of blood loss
  • a trial of labor if placental edge is greater than 2cm from the cervical os
  • monitor bleeding and fhr
  • emergency cesarean birth if signs of fetal distress
45
Q

placenta abruption

A
  • premature separation of the placenta from the wall of the uterus
  • life threatening to both mother and fetus
  • types of placental abruption: partial, complete
46
Q

risk factors of placenta abruption

A
  • hypertension
  • abdominal trauma
  • cocaine, cigarettes, alcohol
  • multiple pregnancy
  • short umbilical cord
  • advanced maternal age
  • history of placental abruption
  • sudden decompression of the uterus
  • prolonged rupture of membranes
47
Q

class 0 for placenta abruption

A

asymptomatic; diagnosed after placental delivery

48
Q

class 1 placenta abruption

A

mild; none or mild vaginal bleeding, slightly tender uterus, normal heart rate and blood pressure and no fetal distress

49
Q

class 2 placenta abruption

A

moderate; none to moderate vaginal bleeding, moderate to severe uterine tenderness, possible board like firmness of abdominal wall, possible severe contractions, maternal bradycardia, orthostatic blood pressure changes, fetal distress, and hypofibrinogenemia

50
Q

hypofibrinogenemia

A

lack of fibrin in the blood, which decreases clotting time

51
Q

class 3 placenta abruption

A

severe; none to severe vaginal bleeding, very painful uterus, boardlike firmness of the abdominal wall, signs of maternal shock, hypofibrinogenemia, poor blood clotting, and possible fetal death

52
Q

placenta accreta

A
  • the placental villi are attached too deeply into the wall of the uterus, causing complications w/ removal
53
Q

3 types of placenta accreta

A

placenta accreta
placenta increta
placenta percreta

54
Q

incidence and risk factors of placenta accreta

A
  • increase in incidence corresponding to the ncreased number of cesarean births
  • abnormalities of the uterine wall
  • low implanted placenta
  • maternal age greater than 35 years
  • previous cesarean delivery, risk increase w/ each delivery
  • risk increases w/ each pregnancy
  • previous placenta accreta
55
Q
A

no signs and symptoms until delivery except for 3rd trimester vaginal bleeding; may be identified on ultrasound examination

56
Q

medical care for placenta accreta

A
  • cesarean birth for an extensive placenta accreta that is diagnosed before or during labor
  • general anesthesia
  • hysterectomy: surgical procedure to rtemove the uterus, is done if the placenta cannot be removed
57
Q

cervical incompetence

A
  • the inability of the uterine cervix to retain pregnancy in the second trimester in teh absence of uterine contractions; also called cervical insufficiency
58
Q

causes of cervical incompetence

A

anatomical abnormality of the uterus, obstetric trauma
- associated w/ treatment for cervical dysplasia and cancer, and multiple pregnancy terminations
- cause is unknown for many women
- usually asymptomatic but pelvic pressure, back pain, increased vaginal discharge, and mild cramping may be noticed

59
Q

medical intervention for incompetent cervix

A
  • surgical cerclage
60
Q

surgical cerclage

A

the use of sutures around the cervix to prevent it from opening, usually performed at 12-14 weeks gestation and removed after 37 weeks gestation or the onset of labor

61
Q

nursing care for incompetent cervix

A
  • after cerclage, monitor for signs of infections, signs of ruptured membranes, bleeding, and uterine activity
  • teach pt the signs of ruptured membranes, infetion, and preterm labor
62
Q

care of the woman with Rh incompatability between maternal and fetal blood

A
  • rh incompatibility occurs if a Rh-negative woman isxposed to fetal blood cells that are Rh-positive
  • isoimmuniaztion may occur
  • antibodies will attack any Rh-positive blood cells. Fetus in teh first pregnancy is rarely affected, but with subsequent pregnancies, alloimmune induced hemoltic anemia can occur
63
Q

isoimmunization

A

occurs when teh immune system produces antibodies against the Rh factor

64
Q

antibodies will attack any…

A

rh positive blood cells
- fetus in the first pregnancy is rarely affected, but with subsequent pregnancies, alloimmune induced hemolytic anemia, can occur

65
Q

incidence and risk factors of rh negative blood type

A
  • 15-20% for Caucasians; 5% to 10% for African Americans; less than 5% for individuals of Chinese and American Indian descent
66
Q

signs and symptoms of alloimmune induced hemolytic anemia

A
  • asymptomatic
  • detected by indirect Coomb’s test
67
Q

medical care for alloimmune induced hemolytic anemia

A
  • blood test to determine Rh and blood type
  • atibody titer test (indirect coombs’ test)
  • repeat the test at 28 weeks’ gestation; evaluate antibody levels at intervals if indirect coombs’ test is positive
  • administer RhoGAM at 28 weeks of gestation
  • amniocentesis
68
Q

care of the woman with multiple gestation pregnancy

A
  • becoming more common and are detected early
69
Q

incidence and risk factors of women w/ mgp

A
  • us twin birth rate is 33.4 per 1000 live births; triplet or higher is 101.4 per 1000,000 live births
  • risks include the use of fertility drugs, advanced maternal age, obesity, family history, or use of art.
70
Q

sins and symptoms of multiple gestation pregnancy

A
  • rapid weight gain and excessive hunger in the first trimester
  • severe nausea and vomiting, and extreme breast tenderness due to higher than usual hormone levels
  • simultaneous fetal movements in different areas
  • uterine size is larger than expected
  • higher than usual levels of hCG and alpha-fetoprotein
  • multiple fetal heartbeasts
71
Q

medical management of mgp

A
  • maintaining the pregnancy as long as possible
  • increased calories and qwell balanced nutrition
  • frequent prenatal visits
  • increased rest or bedrest
  • referrals to a perinatologist or maternal-fetal medicine specialist
  • maternal and fetal testing including ultrasound biophysical profiles
  • monitoring for complications
72
Q

hypertensive disorders that can complicate pregnancy

A
  • chronic hypertension
  • gestational hypertension
73
Q

chronic hypertension

A

the patient is hypertensive even before pregnancy or became hypertensive during early pregnancy
- usually related to obesity or to a strong family history

74
Q

gestational hypertension

A
  • elevated blood pressure that begins in pregnancy and may lead to pre eclampsia if not treated
  • blood pressure usually normalizes after delivery
75
Q

preeclampsia

A

-hypertension and proteinuria after 20 wks of gestation
- edema is commonly present
- incidence: 2% to 6% in healthy nulliparous women

76
Q

risk factors for preeclampsia

A
  • primigravida
  • advanced maternal age (over 35 years)
  • previous history of preeclampsia
  • chronic hypertension and/or renal disease
  • multiple gestations
  • obesity
  • hydatidiform mole
  • egg donation or donor insemination
  • urinary tract infection
77
Q

eclampsia

A
  • when preeclampsia occurs w/ seizure
  • most cases occur in the third trimester, in the first 48 hours of the postpartum eriod
  • incidence: 1 in 2000 pregnancies
78
Q

risk factors for eclampsia

A
  • primigravida
  • family history of preeclampsia
  • multifetal gestation
  • chronic hypertension
  • gestational diabetes
  • obesity
  • lower socioeconomic status
  • vascular and connective tissue disorders
79
Q

HELLP syndrome

A
  • a variant of pre eclampsia and eclampsia that can be life threatening
  • 3 main features: hemolysis, elevated liver, low platelet count
80
Q

risk factors for HELLP syndrome

A
  • caucasian
  • maternal age greater than 35 years
  • history of hypertension
  • previous history of HELLP syndrome
  • specific to the second half of pregnancy
  • an evolving manifestation of a single pathological process with a common origin
  • the placenta
  • the cardiovascular system
  • genetic factors
  • the kidney
  • the liver
  • the immune system
  • the brain and central nervous system
81
Q

gestational diabetes

A
  • the condition in which the blood glucose level is elevated during pregnancy in a woman not previously diagnosed with diabetes
  • caused by insulin resistance, a condition in which the body produces insulin but does not use it effectively
  • production of insulin is not enough to overcome the effects of the placental hormones
  • usually starts halfay through the pregnancy at about 20-24 weeks gestation
  • incidence: 3% to 0% of all pregnancies
82
Q

risk factors for gestational diabetes

A
  • age greater than 25 years
  • physical inactivity
  • obesity with a bmi of 30 or higher
  • previous gestational diabetes
  • previous birth ofa baby weighing more than 9 pounds
  • unexplained stillbirth
  • african american, native american, hispanic, or asian heritage
  • having prediabetes
  • having a parent or sibling with type 2 diabetes
  • history of pcos
  • increased thirst
  • feeling hungrier and eating more than usual
  • increased urination
  • fatigue
  • frequent infections of the bladder, vagina, and skin
  • blurred vision
83
Q

medical management of gestational diabetes

A
  • individualized care based on the subtype of gestational diabetes
  • weekly or biweekly appts
  • 2 step glucose tolerance test at the first prenatal visit
  • all pregnant women should receive an oral GTT between 24th and 28th weeks of pregnancy
  • Hemoglobin A1c, BUN, serum creatinine, thyrotropin, free thyroxine, and capillary blood sugar levels 2-4 times daily in addition to routine pregnancy tests
  • monitor for diabetic ketoacidosis
84
Q

complications of gestational diabetes

A
  • diabetic retinopathy
    = hypertension in diabetic pregnancies can lead to pre eclampsia and stroke
  • accelerated fetal growth, LGA, macrosomia
  • preterm delivery
  • cesarean birth
  • birth injuries: brachial plexus injury, facial nerve injury, and cephalohematoma
  • after birth, infant is at risk for hypoglycemia that may lead to neonatal seizures, coma, and brain damage
  • increased risk for respiratory distress syndrome
  • stillbirth
  • neonatal mortality
85
Q

preventing fetal complications w/ gestational diabetes

A
  • fetal movement counting
  • NSTs
  • contraction stress test
  • ultrasonic biophysical profile
86
Q
A

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