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OB > Chapter 9: Medical Conditions > Flashcards

Chapter 9: Medical Conditions Flashcards

1
Q

Define cervical insufficiency

A

premature dilation of the cervix

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2
Q

Risk factors of cervical insufficiency

A

1) trauma or defects (cervix and/uterus)

2) inutero exposure to diethylstilbestrol

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3
Q

Expected findings of cervical insufficiency

A

1) increase pressure to push
2) contractions (w/ expulsion of fetus)
3) bleeding (pink-tinged)
4) rupture of membranes

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4
Q

1) Diagnostic testing for cervical insufficiency.

2) What results would indicate cervical incompetence?

A

1) Ultrasound

2)
length is <25 mm
shortening of the cervix (funneling)
thinning/ripening (effacement)

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5
Q

1) What surgical procedure can be performed on clients with cervical incompetence/insufficiency?

A

Cerclage

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6
Q

When is it safe to perform a cerclage on clients with cervical incompetence?

When is it removed?

A

12-14 weeks gestation

removed at 37 weeks or when labor occurs

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7
Q

What medication is usually given to inhibit/stop contractions?

A

tocolytics

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8
Q

When discharging a client who had just undergone a cerclage, what education would you provide to the client?

A
  • limit activity & bed rest
  • keep hydrated (dehydration causes contractions)
  • avoid intercourse, tampons, douching
  • report to provider any cervical/uterine changes, in labor (severe perineal pressure, urge to push), strong contractions <5 min apart, rupture of membranes, infection*
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9
Q

Define hyperemesis gravidarum

A

excessive vomiting after 12 weeks

results in weight loss (5%), electrolyte imbalance, acetonuria, ketosis

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10
Q

What risks does hyperemesis gravidarum have on the fetus?

A
  • preterm delivery

- intratuterine growth restriction (IUGR)

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11
Q

Risk factors of hyperemesis gravidarum

A
  • age (<30 yrs old)
  • 1st pregnancy, multifetal gestation
  • hx of hyperemesis gravidarum
  • hx of migraines
  • obesity, DM
  • disorders (GI, hyperthyroid, psychosocial, gestational trophoblastic disease, fetal chromosomal anomalies, increased emotional stress)
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12
Q

Expected findings of hyperemesis gravidarum

A
  • excessive vomiting
  • dehydration
  • weightloss
  • decrease in BP
  • increase in HR
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13
Q

1) Laboratory testing for hyperemesis gravidarum

2) What results from the following test would indicate hyperemesis agravidarum

A

1) UA, Chemistry Profile, CBC, Thyroid test

2)
UA - presence of acetone + ketones

Chemistry Profile:
decrease in Na+, K+, Cl- levels r/t to poor intake, metabolic alkalosis d/t excessive vomiting, metabolic acidosis 2ndary to starvation, elevated liver enzymes, bilirubin levels

Thyroid test indicating hyperthyroidism

CBC: elevated Hct/hemoconcentration

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14
Q

Medications that can help treat hyperemesis gravidarum

A
  • pyridoxine (Vit. B6) (alone or in combo w/ doxylamine)
  • IV lactated ringers
  • supplements
  • antiemetics
  • corticosteriods (unmanageable)
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15
Q

When caring for a client w/ hyperemesis gravidarum, it is important to monitor:

A

VS
Intake and Output
weight
s/s of dehydration (poor skin turgor/dry mucous membranes)

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16
Q

In severe cases in which a client is not able to keep any food down, client may be switched to what type of diet

A 
enteral tube feeding
parenteral nutrition (IV)
17
Q

Risk factors of Iron deficiency

A
  • diet low in iron
  • heavy menses
  • freq. vomiting
  • multifetal gestation
  • <2 years between pregnancies
18
Q

Expected findings in clients with iron deficiency

A

-Pallor, SOB, brittle nails

  • fatigue, irritable
  • HA/dizziness/lightheadedness
  • palpitations
  • unusual cravings (pica)
19
Q

What lab results would indicate a deficiency in iron?

A

Hgb:
<11 mg/dL (1st and 3rd trimester)
<10.5 mg/dL (2nd trimester)

Hct: <3%

20
Q

The recommended iron intake for pregnant women is

A

27 mg/day

21
Q

If maternal iron deficiency is present, dosage should be increased to

A

60-120 mg/day

22
Q

What medications can be given to help with iron deficiency?

A

ferrous sulfate

iron dextran (alternative if iron-sups. cannot be tolerated by patient)

23
Q

What education would you provide to a client taking ferrous sulfate

A
  • take on empty stomach
  • drink w/ OJ to increase absorption
  • encourage diet rich in Vit. C (also help increase absorption)
  • increase absorption of fiber and fluid intake to decrease discomfort of constipation
24
Q

One of the main side effects of taking ferrous sulfate is

A

GI upset

25
Q

Define gestational diabetes mellitus (GDM)

A

impaired tolerance to glucose during pregnancy

26
Q

The ideal blood glucose level during pregnancy is

A

70-100 mg/dL

27
Q

S/S of gestational diabetes usually disappear within a few weeks after delivery.

True/False

A

True

28
Q

Risk factors of GDM

A
  • Age (>25)
  • hx of DM
  • obesity
  • HTN
  • glycosuria
  • previous delivery of an infant that was large or stillborn
29
Q

What implications can GDM have on a baby?

A
  • spontaneous abortion
  • infections
  • ketoacidosis
  • hyper/hypoglycemia
  • hydramnios
30
Q

Clients who are hypoglycemic would exhibit S/S of

A
  • weakness
  • hunger, irritability
  • visual disturbances (blurred vision)
  • nervousness
  • tingling of mouth or extremities
31
Q

Clients who are hyperglycemic would exhibit S/S of

A
  • 3 ps (polyuria/dipsia/phagia)
  • abdominal pain
  • nausea
  • flushed dry skin
  • fruity breath
32
Q

Types of glucose testing during pregnancy

A

1) urinalysis (checks for glycosuria)
2) 1 hr glucose tolerance test w/ 50 g glucose load
3) oral glucose tolerance test (OGTT) w/ 100 g glucose load

33
Q

A positive glucose test would show a blood glucose level of

A

130-140 mg/dL or greater

34
Q

Which glucose testing requires fasting for at least 12 hrs?

A

OGTT

35
Q

Aside from testing a client’s blood glucose levels, ___________ levels should also be checked to assess the severity of ________________.

A

ketone

36
Q

The first intervention to manage GDM is through

A

diet and exercise

37
Q

Medications that can help with managing GDM

A
  • insulin

- oral hypoglycemic therapy (alternative to insulin)

38
Q

What education would you provide to a client w/ GDM

A
  • importance of diet, exercise
  • self-administration of insulin
  • counting daily fetal kicks
  • need for postpartum OGTT and blood glucose test

OB (5 decks)

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