Common Test Flashcards
Risk factor of GDM
Maternal obesity (90kg)
Maternal age older than 25 years
Previous unexplained stillbirth
Previous infant having congenital abnormalities
History of GDM in a previous pregnancy
Family history of DM
Large infant (>4kg)
Fasting glucose >126mg/dl or post glucose >200mg/dl
GDM is diagnosed via
oral glucose tolerance test
≥ 140mg/dl (positive)
< 140mg/dl (negative)
urine for glucose
Blood glucose
Fetal effects of GDM
Congenital abnormalities
Macrosomia(large size)
Intrauterine growth restriction
Birth injury
Delayed lung maturation
Neonatal hypoglycaemia
Neonatal hypocalcemia
Neonatal hyperbilirubinaemia
and jaundice
Neonatal polycythemia
(Hematocrit level>65%)
Perinatal death
Definition of uterine fibroids
Benign growth of the smooth muscle in the wall of the
uterus.
Known as myomas or leiomyomas
Well-circumscribed capsulated tumor, firm to touch
with pinkish appearance
Types of fibroids tumors
Intramural fibroids
- most common
- grow in the wall of the uterus.
Subserosal fibroids
- grow on the outside of the uterus.
- can cause pain due to their size or pressure on nearby organs
Submucosal fibroids
- least common
- grow just underneath the uterine lining and can crowd into the uterus cavity
- lead to urgency, heavy bleeding, infertility, back and pelvic pain with other more serious complications.
Pedunculated fibroids
-grow on small stalks inside or outside the
uterus.
Diagnostic Evaluations of fibroids tumors
Health history - Menstrual pattern - Fertility and child bearing desires - Pain assessment
Pelvic examination (Bimanual examination) - Detect for abdominal lumps
Diagnostic laparoscopy
- To visualize subserosal fibroids (perimetrium lining)
Ultrasound or MRI
- MRI will be able to detect fibroids which is not visible
during an ultrasound
Hysteroscopy ( submucosal fibroids)
- Inspection of uterus cavity
Blood test
- FBC to rule out anaemia
- TSH (thyroid problem)
Rationale for laparoscopy for pt with fibroids tumors
To visualize subserosal fibroids (perimetrium lining)
Rationale for hysterescopy for pt with fibroids tumors
Hysteroscopy ( submucosal fibroids)
- Inspection of uterus cavity
Definition of endometriosis
Endometriosis is the presence of functioning
endometrial glands and stroma outside the uterine
cavity, most often in the pelvic peritoneal cavity
Pathophysiology of Endometriosis
Metaplasia Theory:
• Endometrial tissue develops from embryonic epithelial cells due to hormonal or inflammatory changes: a layer of cells surrounding the ovaries and other cells within the pelvic region are able to change into endometrial cells.
Retrograde Menstruation Theory:
• Menstrual tissue backs up through the fallopian tubes during menses and implants on various pelvic structures due to contraction of smooth muscles.
Transplantation Theory:
• Endometrial implants spread via lymphatic or vascular channels.
Diagnostic evaluation of endometriosis
Health History
• Menstrual pattern
• Fertility status & child bearing desires
• Pain assessment
- Pelvic examination (Bimanual Examination)
• To detect fixed tender nodules round uterus - Full Blood Count (FBC)
• Rule out infection
• Check for anemia due to heavy menses - Diagnostic laparoscopy
• small incision made on the abdomen with camera
• guided instruments inserted to view the pelvic cavity
Definition of ovulation
Expulsion of an ovum from the ovary on
spontaneous rupture of a mature follicle as a
result of cyclic ovarian and pituitary function
It is usually occurs on or about the 11th to the
14th day before the next menstrual period.
Definition of fertilization
Occurs when a sperm penetrates an ovum and unites
with it, each with 23 chromosomes Produces a
zygote with 46 chromosomes
Sperm provides paternal chromosomes
Oocyte provides maternal chromosomes,
Occurs in upper third of uterine tube ( ampulla)
During transport through the fallopian tube, the zygote
undergoes rapid mitotic division or cleavage
Definition of implantation
It involves the attachment, penetration and embedding of the blastocyst in the lining of the uterine wall (endometrium)
Definition of embryonic stage
Development of membranes and
placenta
This stage lasts from day
15 until approximately 8
weeks after conception
End of 8 weeks, all the
organ systems and
external structures are
present
Definition of hyperemesis gavidarum
It refers to persistent and severe vomiting leading to fluid
and electrolyte disturbance, marked ketonuria, nutritional
deficiency and weight loss
Persists beyond the 20th week of pregnancy
(most common in first trimester)
Clinical manifestations of hyperemesis gavidarum
Persistent nausea and vomiting
Inability to retain food and fluids
Significant weight loss ( more than 5% prepregnant
weight)
Dehydration as evidenced by dry tongue and mucous
membranes, decreased turgor of the skin, scant and
concentrated urine
Electrolytes and acid-based imbalanced
Ketonuria
Nursing diagnosis of Hyperemesis Gavidarum
Fluid volume deficit related to severe vomiting
Impaired nutrition, less than body requirement related
to inability to tolerate fluids and foods
Anxiety related to ineffective coping of persistent and
severe vomiting
Nursing Intervention of Hyperemesis Gavidarum
Fluid and nutritional balance:
Monitor vitals signs for dehydration such as tachycardic and hypotension.
Assess for signs and symptoms for dehydration such as dry lips and mucosa, decreased skin turgor and sunken eyes to determine the severity of dehydration.
Maintain Nil By Mouth (NBM) status to allow GI tract to rest.
Administer antiemetic drugs as ordered e.g. Maxolon, IV Zofran.
Administer IV Dextrose 5% in lactated ringer
Monitor intake and output chart to assess fluid balance and determine fluid replacement.
Daily weight to assess fluid balance.
Introduce small amounts of oral fluid and food gradually when patient’s nausea and vomiting subsided for better toleration.
Comfort:
- Ensure comfort in oral cavity by providing oral hygiene, lips therapy and oral gel.
- Grouping nursing care to avoid unnecessary disturbances to provide maximum rest.
3.Emotional support
Listen to her concerns and feelings by answering all her questions
Teach the patient about therapeutic lifestyle changes like avoid stressors
and fatigue
Health teaching
Take frequent, small amounts of food and fluid, to prevent the
stomach becoming too full
Eat easily digested carbohydrates, e.g. crackers to avoid empty
stomach
Sitting upright after meals at least 2 hours after eating, to reduce
gastric reflux into the esophagus
Avoid noxious stimuli to prevent triggers that cause nausea and
vomiting
Nursing Intervention of Hyperemesis Gavidarum ( Fluid and nutritional balance )
Fluid and nutritional balance
Monitor vitals signs for dehydration such as tachycardic and hypotension.
Assess for signs and symptoms for dehydration such as dry lips and mucosa,
decreased skin turgor and sunken eyes to determine the severity of dehydration.
Maintain Nil By Mouth (NBM) status to allow GI tract to rest.
Administer antiemetic drugs as ordered e.g. Maxolon, IV Zofran.
Administer IV Dextrose 5% in lactated ringer
Monitor intake and output chart to assess fluid balance and determine fluid
replacement.
Daily weight to assess fluid balance.
Introduce small amounts of oral fluid and food gradually when patient’s nausea
and vomiting subsided for better toleration.
Nursing Intervention of Hyperemesis Gavidarum ( Health teaching)
Take frequent, small amounts of food and fluid, to prevent the
stomach becoming too full
Eat easily digested carbohydrates, e.g. crackers to avoid empty
stomach
Sitting upright after meals at least 2 hours after eating, to reduce
gastric reflux into the esophagus
Avoid noxious stimuli to prevent triggers that cause nausea and
vomiting
Nursing Intervention of Hyperemesis Gavidarum ( Comfort )
Ensure comfort in oral cavity by providing oral hygiene, lips
therapy and oral gel.
Grouping nursing care to avoid unnecessary disturbances to
provide maximum rest.
Nursing Intervention of Hyperemesis Gavidarum (Emotional support)
Listen to her concerns and feelings by answering all her questions
Teach the patient about therapeutic lifestyle changes like avoid stressors
and fatigue
Mild pre-eclampsia
BP: ≥ 140/90 mmHg but less than
160mmHg; diastolic greater
than 90mmHg but less than
<110mmHg
Proteinuria: Trace to 1+
Oedema: Trace to 1+ pedal, if present
Headache: Absent
Epigastric pain: Absent
Visual problems: Absent
Reflexes: Maybe normal
Serum creatinine: Normal
Platelets: Normal
Liver enzymes: Normal or minimal
Severe pre-eclampsia
BP: ≥ 160/110 mmHg and greater
Proteinuria: ≥ 2+ to 3+
Oedema: Oedema ±; oedema of face or
hand is significant
Headache: Severe
Epigastric pain: Present
Visual problems :Blurred, photophobia
Reflexes: Hyperreflexia >3+ possible
ankle clonus
Serum creatinine: elevated
Platelets : Decreased
Liver enzymes: Markedly elevated
Clinical Manifestation of severe pre-eclampsia
Central Nervous System:
Severe headache (brain edema and small cerebral haemorrhages)
Hyperactive deep tendon reflexes (CNS irritability)
Eyes:
Visual disturbances (blurred or double vision or ‘spots before the eyes’) due to arterial spasm and edema surrounding the retina
Urinary tract:
Reduces urine production and worsens hypertension due to decrease
blood flow to the kidneys
Respiratory system:
▪Dyspnoea due to pulmonary edema (accumulation of fluid in the lungs)
Gastrointestinal system and liver:
▪Epigastric pain or nausea due to liver edema, ischaemia and necrosis
Blood clotting:
▪HELLP syndrome
▪Involves haemolysis, elevated liver enzymes and low platelets
Nursing management of pre-eclampsia
PE monitoring chart
Daily weight measurement – to assess for retention of fluid
Strict I/O monitoring – prevent fluid overload and ensure adequate kidney function
Insert Indwelling catheter – monitor output every hour
(30ml / hour)
- Send Urine C/S, FEME
Continuous fetal monitoring with CTG/Doppler – monitor the well being of the fetus
Check daily urine protein (dipstick) to measure the amount of protein in the urine
Explain and reassure patients – provide emotional support
Nursed in a quiet environment
Nurse management of eclampsia
Activate Code Blue if patient having seizures
Ensure patent airway by turning patient to left lateral and suctioning of mouth to clear secretion.
Administer Oxygen at 6-8 litres/min by face mask
Protect patient from injury during seizures
- Note duration of seizures
Administer anti-hypertensive, anti-convulsive as ordered
Close monitoring of parameters as per pre-eclampsia management
Observe for uterine contractions and vaginal loss after seizures
Transfer to ICU and prepare for delivery after seizures
Definition of abortion
Abortion: Termination of pregnancy before viability
(20 weeks of gestations), either spontaneous or
induced
Definition of Miscarriage
Miscarriage: Spontaneous termination of
pregnancy before viability (20 weeks of gestations)
– Also known as spontaneous abortion
Definition of Termination of pregnancy (TOP)
It is a procedure to terminate a pregnancy by using medical or surgical methods before 20 weeks of gestation
– Also known as induced abortion
Types of abortion
Spontaneous abortion:
Threatened abortion
Inevitable abortion
Incomplete abortion
Complete abortion
Missed abortion
Recurrent abortion
Induced abortion:
Therapeutic abortion
Elective abortion
Threatened abortion
REFER TO SLIDES
Inevitable abortion
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Incomplete abortion
Refer to slides
Complete abortion
Refer to slides
Missed abortion
Refer to slides
Recurrent abortion
Refer to slides
Therapeutic abortion
Refer to slides
Elective abortion
Refer to slides
Risk factors of miscarriage
- Maternal age – more than 35 years • Increased gravidity • Previous history of miscarriage • Multiple pregnancy • In-vitro fertilization • Polycystic ovarian syndrome (PCOS)
Clinical manifestations of miscarriage
Amenorrhoea
Vaginal bleeding
Lower abdominal cramping/pain
Positive pregnancy test
(hCG)
Vaginal examination – cervix closed/dilate
Diagnostic evaluations of miscarriage
- Full blood count (FBC)
- Blood urea and serum electrolytes
- Blood grouping and x-match
- Urine FEME
- Urine Pregnancy test (hCG)
- Ultrasound of abdomen
Nursing diagnosis of miscarriage
Grief related to loss of anticipated infant
Risk of infections related to the retain of
product of conception
Risk for fluid volume deficit related to
excessive bleeding
IMPORTANT : LOOK AT BODY TEMPERATURE
IF TEMPERATURE STILL LOW, (RISK) OF INFECTION
Nursing interventions of miscarriage
Psychological care:
a) Counselling referral
b) Support group
c) Provide adequate space and time for the couple to grief
Observation:
a) Monitor vital signs (hourly blood pressure, pulse, respiration rate and 4 hourly
temperature -> post-operative complications such as hypovolemic shock
b) Observe pad chart for the amount and characteristic of discharge -> determine
amount of blood loss.
c) Monitor for post-operative complications such as hypovolemic shock, pelvic
infection -> to provide early intervention
Complications of Miscarriage
- Hemorrhage
• Infection
• Sepsis
• Death
Definition of ectopic pregnancy
Ectopic Pregnancy occurs when the fertilized ovum (zygote) is implanted outside the uterine cavity such as fallopian tube, ovary, abdomen or the cervix
Occurs at first trimester before 13 weeks of gestation
Clinical manifestations of ruptured ectopic pregnancy
Cramping pain and tenderness over the pelvic region,
lower back, abdomen or pelvic region
• Shoulder and neck pain caused by accumulating
intraperitoneal blood that irritates the diaphram
• Vaginal bleeding (a large of mass clotted blood
collected in the pelvis)
Signs of hypovolemic shock and haemorrhage:
- Pallor
- Rapid, thready pulse
- Decreased blood pressure
- Sweating
- Subnormal temperature
- Restlessness
Nursing diagnosis of ruptured ectopic pregnancy
Lower abdominal pain related to inflammation or
ruptured of the fallopian tube
Fluid volume deficit related to bleeding from a
ruptured ectopic pregnancy
Bleeding related to rupture of the fallopian tube
Anxiety related to effect of surgery on fertility
Grieving related to loss of pregnancy loss
Immediate nursing interventions of ectopic pregnancy
- Monitor the vital signs (Blood pressure, pulse rate and respiration rate) every 15 mins if actively bleeding and temperature 4 hourly
(R) increase pulse rate and drop in blood pressure will indicate hypovolemic shock and infection. - Administer IV Normal Saline if patient is Nil by mouth (if actively bleeding due to ruptured fallopian tube)
(R) To replace blood and fluid loss - Monitor the intake and output (Urinary catheterization - 30ml/hr)
(R) to monitor renal function and hydration status - Monitor pad chart
(R) To note the colour and amount of blood loss ( if ruptured fallopian tube) - Observe for signs and symptoms of hypovolemic shock
(R) To prevent patient compromised - Administer oxygen if necessary
(R) to increase the amount oxygen saturation - Provide emotional support
(R) To allay fear and anxiety - Pain management - observe for presence and location
(R) to promote comfort and relief pain - Blood transfusion if excessive bleeding
( R) to replace blood loss - Prepare for surgery if there is excessive bleeding due to ruptured fallopian tube
(R) To prevent patient compromised
Complications of ectopic pregnancy
Ruptured Ectopic Pregnancy
Hypovolemic shock
Recurrent of ectopic pregnancy
First stage of labour
Begins from the onset of
regular uterine contractions
to full dilatation of the cervix
Divided into 2 phases:
• Latent phase
• Active phase
Nursing Intervention for 1st stage of labour
- Monitor vital signs, hourly pulse rate, respiration
rate, blood pressure and 4 hourly temperature
(R) To detect for bleeding, dehydration and infection - Assess status of labour
• Monitor uterine contractions by placing the entire
hand lightly on the uterine fundus
(R) To assess the progress of labour - Perform 4 hourly or PRN vaginal examination to assess for:
• Cervical effacement and dilatation, of
• Fetal descent
• Membranes – present or absent
• Colour of the amniotic fluid (liquid)
(R) To monitor the progress of labour and fetal distress - Assessment of the perineum
- perineum bulging
- anus gaping
(R) To observe for signs of second stage - Monitor of the fetal heart rate (FHR) using doppler or
CTG
• Normal FHR: 110 – 160 bpm
• Bradycardia: below 110 bpm
• Tachycardia: above 160 bpm
(R) For early detection of fetal hypoxia and to provide
prompt interventions
Purpose of CTG
Assess and document fetal heart
rate
Assess and document the
duration, frequency and intensity
of uterine contractions
Second stage of labour
Begins with full dilatation of the cervix to the birth of the baby
Third stage of labour
From the birth of the baby till the expulsion of
placenta and membranes and the bleeding stop
Fourth stage of labour
1 to 4 hours after birth
Physiologic readjustment of mother’s body begin
Haemodynamic changes occur (to observe in the
woman):
• Blood loss of 250 – 500ml of blood
Loss of blood and removal of weight from the pregnant
uterus from surrounding vessels allows redistribution
of blood onto venous beds
Results in moderate drop in SBP & DBP, increased
pulse pressure and moderate tachycardia
Immediate care for mother after normal vaginal behaviour
Monitor vital signs every hour (blood pressure, temperature, pulse rate & respiration rate) – to detect for bleeding
Check the uterine contraction for the location and firmness of uterine fundus – to ensure no uterine atony
Monitor the pad chart, note the amount and colour of lochia to detect for post partum haemorrhage
Check condition of episiotomy wound and perineum, to note for bleeding from the laceration/episiotomy and haematoma
Monitor IV infusion and medication as ordered by Dr
Administer of oxytocin infusion as needed to
contract the uterus
Pain management, to observe for presence and
location of pain – to relief pain and promote comfort
Observe for bladder distension as full bladder hinder
uterine contractions that may lead to post partum
haemorrhage
Check the level of sensation and ability to move
lower extremities if epidural anaesthesia is used
Promote comfort
Description of uterine contractions
Descriptions of uterine contractions
• Frequency: the elapsed time between the beginning of
one contraction until the beginning of the next
contraction (e.g contraction every 15 mins)
• Duration: the elapsed timed from the beginning to the
end of the same contraction (e.g lasting 45 to 50
seconds)
• Intensity: approximate strength of contraction
- Ranges from mild → moderate → strong
• Interval: the amount of time the uterus relaxes between
contractions
Increment:
period of increasing of the contraction
Acme:
Peak of the contraction
Decrement:
decreasing strength of the contraction
Definition of episotomy
A surgical incision of the perineal body to enlarge the
outlet
Has been thought to minimize risk of lacerations of the
perineum and overstretching of the perineal tissues
Risks of episiotomy
• Increase the risk of fourth-degree perineal lacerations
• Major perineal trauma (extension to or through the
anal sphincter) more likely to happen if midline
episiotomy done
• Blood loss, infection, pain and discomfort for weeks
after delivery
• Painful intercourse
Metaplasia theory
Endometrial tissues develop from embryonic epithelial cells due to inflammatory and hormonal changes whereby a layer of cells surrounding the ovaries and other cells within the pelvic region are able to change into endometrial cells
