Class 6 Study Guide Flashcards
Hyperemeisis Gravidarum is associated with-
- loss of 5% or more of prepregnancy weight
- dehydration
- acidosis from starvation
- elevated blood and urine ketones
- alkalosis from loss of hydrochloric acid in gastric fluids
- hypokalemia
Hyperemesis Gravidarum s/s
- elevated hct and hgb due to dehydration
- low sodium,potassium and chloride
- high creat due to renal dysfunction
Hyperemesis Gravidarum etiology
- unmarried white women
- first pregnancy
- multifetal pregnancy
- elevated hormones
- H. pylori
When does gestational HTN appear
-after 20 weeks of pregnancy that isn’t accompanied by proteinuria
When does preeclampsia appear
-after 20 weeks of pregnancy with proteinura
Preeclampsia patho
- result of generalized vasopasm
- blood volume increases, CO increases and BP remains the same, but PVR decreases normally
- in preeclampsia, PVR increases instead of decrease
- this causes reduced diameter of blood vessels, impeded blood flow, elevated blood pressure,circulation decreases
- decreased renal perfusion reduced GFR and causes glomerule damage (protein excretion), fluid shift (hypovolemia and edema), epigastric pain(liver involvement), small cerebral hemorrhages (blurred vision, see spots, hyperreflexia), pulmonary edema (deyspnea), and decreased placental circulation (IUGR, fetal hypoxemia)
Home management for preeclampsia
- if mild and stable:
- activity restriction
- monitor fetal activity
- monitor bp multiple times a day
- weight each morning
- UA
- good diet
Antepartum management in hospital for preeclampsia
If severe:
- multisystem involvement
- bed rest
- quiet environment
- anticonvulsant meds (mag sulfate)
- antihypertensives
Intrapartum management for preeclampsia
- most seizures occur during labor and PP
- lateral position
- analgesics
- induced if deterioration
- vaginal birth
- oxytocin and mag sulfate with continued EFM (decreased variability due to mag sulfate)
Postpartum Management for preeclampsia
- assess EBl and shock
- continuefor48 hours
- S/S of recovery: 4-6 L/day, decreased protein in urine, lab improvement, bp WNL in 2 weeks
4 priority assessments for Mag Sulfate
- respiration >12
- O2 sat >95
- presence of DTR
- U/O >30mL/hr
- (clonus)
Magnesium Sulfate Toxicity
- respiratory depression
- absent DTRs
- sweating
- flushing
- confusion
- lethargy
- slurring of speach
- drowsiness
- disorientation
- hypotension
- D/C mag, notify physician
- have calcium gluconate readily available for antidote
Coombs test done at ______ and give Rhogam within _____ of birth
- 28 weeks
- 72 hours
Classification of DM
- Type 1
- Type 2
- Gestational
Type 1: -insulin dependance -autoimmune of beta cells -prone to ketosis Type 2: -diet controlled or insulin dependent -insulin resistance -ketosis less likely Gestational: -onset first diagnosed with pregnancy -GDM A1 diet control GDM A2 insulin control with diet
Pre existing DM during first trimester fetal risk
- increase risk of spontaneous abortion and fetal complications
- congenital malformations: neural tube defects, cardiac
GDM results: Fasting: 1hr: 2hr: 3hr:
- > 95
- > 180
- > 155
- > 140
Hypotonic Dysfunction
- most common
- weak contractions
- fetal hypoxia not usually seen
Hypertonic Dysfunction
- painful ineffective contractions
- fetal hypoxia/stress
Two problems with the passage
- full bladder
- small pelvis
Normal Active labor progression
- 1.2-1.5 cm/hr dilation
- 1-2 cm/hr fetal decent
Assessment findings for intrauterine infection
- FHR will be tachycardic
- maternal fever
- maternal tachypnea or cardia
- amniotic fluid may have odor and not be clear
Associated Factors with preterm labor
- UTI
- infections
- DM
- HTN
- drugs
- obesity
- IVF
- previous preterm birth
- multifetal
- preeclampsia
- bleeding
- IUGR
- inadequeteamnioticfluid
- bad prenatal care
- violence
- smoking
- homeless
2 benefits for Betamethasone
- accelerate fetal lung maturity
- reduces incidence of IVH
- greatest benefit if at least 24 hour s between initial dose and birth of preterm infant
Prolapsed Cord S/S
-Complete vs occult
- complete: cord is visible at vaginal opening, if not visible may be palpated
- Occult: cord slips alongside head or shoulders, cant be palpated or seen. Changes in FHR (brady with variable decels)
