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WCH 2.2 > Common Test > Flashcards

Common Test Flashcards

1
Q

Risk factor of GDM

A

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

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2
Q

GDM is diagnosed via

A

oral glucose tolerance test
≥ 140mg/dl (positive)
< 140mg/dl (negative)

urine for glucose

Blood glucose

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3
Q

Fetal effects of GDM

A

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

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4
Q

Definition of uterine fibroids

A

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

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5
Q

Types of fibroids tumors

A

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.

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6
Q

Diagnostic Evaluations of fibroids tumors

A 
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)
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7
Q

Rationale for laparoscopy for pt with fibroids tumors

A

To visualize subserosal fibroids (perimetrium lining)

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8
Q

Rationale for hysterescopy for pt with fibroids tumors

A

Hysteroscopy ( submucosal fibroids)

- Inspection of uterus cavity

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9
Q

Definition of endometriosis

A

Endometriosis is the presence of functioning
endometrial glands and stroma outside the uterine
cavity, most often in the pelvic peritoneal cavity

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10
Q

Pathophysiology of Endometriosis

A

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.

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11
Q

Diagnostic evaluation of endometriosis

A

Health History
• Menstrual pattern
• Fertility status & child bearing desires
• Pain assessment

  1. Pelvic examination (Bimanual Examination)
    • To detect fixed tender nodules round uterus
  2. Full Blood Count (FBC)
    • Rule out infection
    • Check for anemia due to heavy menses
  3. Diagnostic laparoscopy
    • small incision made on the abdomen with camera
    • guided instruments inserted to view the pelvic cavity
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12
Q

Definition of ovulation

A

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.

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13
Q

Definition of fertilization

A

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

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14
Q

Definition of implantation

A 
It involves the attachment,
penetration and embedding
of the blastocyst in the
lining of the uterine wall
(endometrium)
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15
Q

Definition of embryonic stage

A

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

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16
Q

Definition of hyperemesis gavidarum

A

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)

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17
Q

Clinical manifestations of hyperemesis gavidarum

A

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

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18
Q

Nursing diagnosis of Hyperemesis Gavidarum

A

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

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19
Q

Nursing Intervention of Hyperemesis Gavidarum

A

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

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20
Q

Nursing Intervention of Hyperemesis Gavidarum ( Fluid and nutritional balance )

A

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.

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21
Q

Nursing Intervention of Hyperemesis Gavidarum ( Health teaching)

A

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

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22
Q

Nursing Intervention of Hyperemesis Gavidarum ( Comfort )

A

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.

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23
Q

Nursing Intervention of Hyperemesis Gavidarum (Emotional support)

A

Listen to her concerns and feelings by answering all her questions
Teach the patient about therapeutic lifestyle changes like avoid stressors
and fatigue

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24
Q

Mild pre-eclampsia

A

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

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25
Q

Severe pre-eclampsia

A

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

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26
Q

Clinical Manifestation of severe pre-eclampsia

A

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

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27
Q

Nursing management of pre-eclampsia

A

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

28
Q

Nurse management of eclampsia

A

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

29
Q

Definition of abortion

A

Abortion: Termination of pregnancy before viability
(20 weeks of gestations), either spontaneous or
induced

30
Q

Definition of Miscarriage

A

Miscarriage: Spontaneous termination of
pregnancy before viability (20 weeks of gestations)
– Also known as spontaneous abortion

31
Q

Definition of Termination of pregnancy (TOP)

A

It is a procedure to terminate a pregnancy by using medical or surgical methods before 20 weeks of gestation
– Also known as induced abortion

32
Q

Types of abortion

A

Spontaneous abortion:

Threatened abortion

Inevitable abortion

Incomplete abortion

Complete abortion

Missed abortion

Recurrent abortion

Induced abortion:

Therapeutic abortion

Elective abortion

33
Q

Threatened abortion

A

REFER TO SLIDES

34
Q

Inevitable abortion

A

Refer to slides

35
Q

Incomplete abortion

A

Refer to slides

36
Q

Complete abortion

A

Refer to slides

37
Q

Missed abortion

A

Refer to slides

38
Q

Recurrent abortion

A

Refer to slides

39
Q

Therapeutic abortion

A

Refer to slides

40
Q

Elective abortion

A

Refer to slides

41
Q

Risk factors of miscarriage

A 
- Maternal age – more than 35 years
• Increased gravidity
• Previous history of miscarriage
• Multiple pregnancy
• In-vitro fertilization
• Polycystic ovarian syndrome (PCOS)
42
Q

Clinical manifestations of miscarriage

A

Amenorrhoea

Vaginal bleeding

Lower abdominal cramping/pain

Positive pregnancy test
(hCG)

Vaginal examination – cervix closed/dilate

43
Q

Diagnostic evaluations of miscarriage

A
  1. Full blood count (FBC)
  2. Blood urea and serum electrolytes
  3. Blood grouping and x-match
  4. Urine FEME
  5. Urine Pregnancy test (hCG)
  6. Ultrasound of abdomen
44
Q

Nursing diagnosis of miscarriage

A

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

45
Q

Nursing interventions of miscarriage

A

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

46
Q

Complications of Miscarriage

A
  • Hemorrhage
    • Infection
    • Sepsis
    • Death
47
Q

Definition of ectopic pregnancy

A

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

48
Q

Clinical manifestations of ruptured ectopic pregnancy

A

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
49
Q

Nursing diagnosis of ruptured ectopic pregnancy

A

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

50
Q

Immediate nursing interventions of ectopic pregnancy

A
  1. 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.
  2. 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
  3. Monitor the intake and output (Urinary catheterization - 30ml/hr)
    (R) to monitor renal function and hydration status
  4. Monitor pad chart
    (R) To note the colour and amount of blood loss ( if ruptured fallopian tube)
  5. Observe for signs and symptoms of hypovolemic shock
    (R) To prevent patient compromised
  6. Administer oxygen if necessary
    (R) to increase the amount oxygen saturation
  7. Provide emotional support
    (R) To allay fear and anxiety
  8. Pain management - observe for presence and location
    (R) to promote comfort and relief pain
  9. Blood transfusion if excessive bleeding
    ( R) to replace blood loss
  10. Prepare for surgery if there is excessive bleeding due to ruptured fallopian tube
    (R) To prevent patient compromised
51
Q

Complications of ectopic pregnancy

A

Ruptured Ectopic Pregnancy

Hypovolemic shock

Recurrent of ectopic pregnancy

52
Q

First stage of labour

A

Begins from the onset of
regular uterine contractions
to full dilatation of the cervix

Divided into 2 phases:
• Latent phase
• Active phase

53
Q

Nursing Intervention for 1st stage of labour

A
  1. Monitor vital signs, hourly pulse rate, respiration
    rate, blood pressure and 4 hourly temperature
    (R) To detect for bleeding, dehydration and infection
  2. Assess status of labour
    • Monitor uterine contractions by placing the entire
    hand lightly on the uterine fundus
    (R) To assess the progress of labour
  3. 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
  4. Assessment of the perineum
    - perineum bulging
    - anus gaping
    (R) To observe for signs of second stage
  5. 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
54
Q

Purpose of CTG

A

Assess and document fetal heart
rate

Assess and document the
duration, frequency and intensity
of uterine contractions

55
Q

Second stage of labour

A

Begins with full dilatation of the cervix to the birth of the baby

56
Q

Third stage of labour

A

From the birth of the baby till the expulsion of

placenta and membranes and the bleeding stop

57
Q

Fourth stage of labour

A

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

58
Q

Immediate care for mother after normal vaginal behaviour

A

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

59
Q

Description of uterine contractions

A

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

60
Q

Increment:

A

period of increasing of the contraction

61
Q

Acme:

A

Peak of the contraction

62
Q

Decrement:

A

decreasing strength of the contraction

63
Q

Definition of episotomy

A

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

64
Q

Risks of episiotomy

A

• 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

65
Q

Metaplasia theory

A

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

WCH 2.2 (4 decks)

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