Chapter 9: Medical Conditions Flashcards
Define cervical insufficiency
premature dilation of the cervix
Risk factors of cervical insufficiency
1) trauma or defects (cervix and/uterus)
2) inutero exposure to diethylstilbestrol
Expected findings of cervical insufficiency
1) increase pressure to push
2) contractions (w/ expulsion of fetus)
3) bleeding (pink-tinged)
4) rupture of membranes
1) Diagnostic testing for cervical insufficiency.
2) What results would indicate cervical incompetence?
1) Ultrasound
2)
length is <25 mm
shortening of the cervix (funneling)
thinning/ripening (effacement)
1) What surgical procedure can be performed on clients with cervical incompetence/insufficiency?
Cerclage
When is it safe to perform a cerclage on clients with cervical incompetence?
When is it removed?
12-14 weeks gestation
removed at 37 weeks or when labor occurs
What medication is usually given to inhibit/stop contractions?
tocolytics
When discharging a client who had just undergone a cerclage, what education would you provide to the client?
- 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*
Define hyperemesis gravidarum
excessive vomiting after 12 weeks
results in weight loss (5%), electrolyte imbalance, acetonuria, ketosis
What risks does hyperemesis gravidarum have on the fetus?
- preterm delivery
- intratuterine growth restriction (IUGR)
Risk factors of hyperemesis gravidarum
- 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)
Expected findings of hyperemesis gravidarum
- excessive vomiting
- dehydration
- weightloss
- decrease in BP
- increase in HR
1) Laboratory testing for hyperemesis gravidarum
2) What results from the following test would indicate hyperemesis agravidarum
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
Medications that can help treat hyperemesis gravidarum
- pyridoxine (Vit. B6) (alone or in combo w/ doxylamine)
- IV lactated ringers
- supplements
- antiemetics
- corticosteriods (unmanageable)
When caring for a client w/ hyperemesis gravidarum, it is important to monitor:
VS
Intake and Output
weight
s/s of dehydration (poor skin turgor/dry mucous membranes)
In severe cases in which a client is not able to keep any food down, client may be switched to what type of diet
enteral tube feeding parenteral nutrition (IV)
Risk factors of Iron deficiency
- diet low in iron
- heavy menses
- freq. vomiting
- multifetal gestation
- <2 years between pregnancies
Expected findings in clients with iron deficiency
-Pallor, SOB, brittle nails
- fatigue, irritable
- HA/dizziness/lightheadedness
- palpitations
- unusual cravings (pica)
What lab results would indicate a deficiency in iron?
Hgb:
<11 mg/dL (1st and 3rd trimester)
<10.5 mg/dL (2nd trimester)
Hct: <3%
The recommended iron intake for pregnant women is
27 mg/day
If maternal iron deficiency is present, dosage should be increased to
60-120 mg/day
What medications can be given to help with iron deficiency?
ferrous sulfate
iron dextran (alternative if iron-sups. cannot be tolerated by patient)
What education would you provide to a client taking ferrous sulfate
- 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
One of the main side effects of taking ferrous sulfate is
GI upset
