Complicated pregnancy PPT Flashcards
1st Trimester
Mom’s risk 2
Spontaneous abortion
Ectopic pregnancy
GTD
Infection
-UTI
-Vaginal discharge
1st Trimester infection
UTI
expecting finds
Burning with urination
Fever
Severe back pain
Call for early signs of UTI
1st Trimester infection
Vaginal discharge
Heavy white discharge
Fishy odor
Indicate yeast or Bacterial vaginosis
1st Trimester infection
Prevention
Infections during pregnancy
Hand washing, hand sanitizer
Condom use
Avoiding sick people
Infections that harm the fetus 4
Gonorrhea and Chlamydia
Syphilis
Group B Strep
TORCH
Toxoplasmosis
Other infections
Rubella
Cytomegalovirus
HSV
What is STI?
What is STD?
Sexually transmitted infection
sexually transmitted disease
No matter which term people use, they’re talking about the same thing: infections that get passed from one person to another during sex.
Gonorrhea and Chlamydia
Characteristics
STI
Chlamydia is most common STI
Reportable diseases
If it untreated, it can lead to pelvic inflammatory disease (PID)
Gonorrhea and Chlamydia
Treatment
Should be treated if diagnosed and all neonates should receive erythromycin ointment in the eye
Syphilis
Characteristics
STI
3 stages
Report disease
Syphilis
Test how and when?
RPR-rapid plasma regain is a screening test
All women should be screened at the first prenatal visit
And the again in the 3rd trimester if at high risk
Group B Strep
Characteristics
Can pass go a fetus during labor and delivery
Vaginal flora infection is NOT STI
Group B Strep
Treatment
Women should be screened
Administered during labor
Penicillin G
Ampicillin
TORCH
Characteristics
These infections cross the placenta
Teratogenic effects of the fetus Treatment depends on the infection
Treatment
a)Toxoplasmosis
b) Rubella
c) Cytomegalovirus
a) from raw food or cat feces
Often no symptoms
b) Casual contact with infected people
Immunization
c) STI
No treatment
d) STI
Transmit during virginial birth
1st Trimester
2nd?
3rd?
1st till week 12
2nd week 13 to 26
3rd week 27 to the end
1st Trimester complications
Herpes Simplex
a) How to transmit?
b) Medication
a)
through the placenta
Usually transmitted during vaginal delivery
b)
acyclovir
Not guarantee viral transmission will not occur at birth
1st Trimester complications
HIV
a) When it transmits?
b) Treatment
a)
through the placenta
during delivery
b)
Antiretroviral therapy
but does not guarantee viral transmission will not occur
1st Trimester complications
HIV
What test should avoid?
amniocentesis
placement of internal monitors
episiotomies
After birth neonatal injections should be withheld until after the first bath is given
Amniocentesis?
between the 15th and 20th weeks
at greater risk for birth defects
Episiotomies?
A cut (incision) made in the tissue between the vaginal opening and the anus during childbirth
Warning Signs
1st trimester
Bleeding
Infection >100.4
Vomiting
Abdominal pain
Warning Signs 1st trimester
What waring sing
Bleeding
Abdominal pain
Abortion
Ectopic
Placenta previa
Hydatidiform mole
Hydatidiform mole
A noncancerous tumor that develops in the uterus
Warning Signs 1st trimester
What waring sing
Vomiting how to asses?
greater than twice a day
severe nausea
enough to prevent eating and drinking.
Assess amount of vomiting, weight loss, electrolyte imbalance.
1st trimester complications
a) Many of the complications of pregnancy are diagnosed at ER, why?
b) Assess & address issues with hemodynamic stability of the mother FIRST. Once mom is stable, check on the fetus, next. Why?
c) MAINTAIN NPO until diagnosis confirmed and treatment plan established. Why?
a) Women may not know they are pregnant
b)If the mother is not hemodynamically stable the fetus isn’t getting perfused. The uterus is not a vital organ
c) Surgery may be required
hemodynamic stability = stable blood flow
1-hour glucose check
Teaching
Fasting not required
Drink something called Glucola
No food and drink after Glucola
Blood is drawn after one hour
Abnormal >140
>200 no need 3hr test
3-Hour Glucose Tolerance
Teaching?
Diagnosis test
Need to be fasting
No food and drink after Glucola until the test is complete
Need Diet assessment, iron supplementation with teaching
3-Hour Glucose Tolerance Test
Diagnosis rang
Diagnosis is made with 2 values above these thresholds
Fasting: 95 mg/dL
1-hour: 180 mg/dL
2-hours: 155 mg/dL
3-hours: 140 mg/dL
Gestational diabetes
Plan of care
Limited carb
Exercise
Daily fetal kick counts from 28 weeks
Delivery may be recommended no later than EDB d/t poor placenta perfusion
Delivery by 38 weeks recommended
Breastfeeding recommended
Complications
related to gestational diabetes
Inc risk for yeast infections
Inc LGA baby < 4kg
C/S
trauma
For infant
Shoulder dystocia
hypoglycemia after birth
RDS r/t decreased surfactant
Hyperbilirubinemia r/t polycythemia
Infant at greater risk for Type 2 diabetes later in life
Rose Type 2 diabetes
She switch to insulin before getting pregnant
She wants to have family soon
Teaching?
Glucose control with the insulin
Start folic acid now
Review family history for any genetic disorders
Start a exercise program now
Rose who has diabetes type 2
pregnant.
How soon should she be seen?
Teaching?
Before 12 weeks
1st trimester insulin needs drop
Risk for hypoglycemia
Lab work to determine baseline kidney function
Ophthalmology consult recommended
眼科
Type 2 diabetes
Risk for during pregnancy
Hydramnios
Preterm delivery
Preeclampsia
Hyperglycemia
UTIs, yeast infections
Poor wound healing
Difficult labor
Hydramnios?
A condition that occurs when too much amniotic fluid builds up during pregnancy
Preeclampsia?
High blood pressure (hypertension) disorder that can occur during pregnancy.
Macrosomia?
Growth beyond a specific threshold
Weight above 4500 g
Type 2 diabetes
Risk for during pregnancy
Vascular damage
SGA
IUGR
Require early delivery r/t inadequate perfusion.
SGA?
Small for gestational age
A baby who is smaller than the usual amount for the number of weeks of pregnancy
IUGR
Intrauterine growth restriction
A condition in which a baby doesn’t grow to normal weight during pregnancy
Type 2 diabetes
Risk for during pregnancy
BG is not well controlled
fetal anomalies
-especially cardiac defect
poor perfusion!!
Type 2 diabetes
How will insulin dose change as her pregnancy continues?
Dec first trimester
Then inc incrementally over the rest of the pregnancy
incrementally 徐々に
DM Type 1
Expecting findings
Wt loss is from too little insulin
Dehydration
Proteinuria
Dec BP r/t dec fluid volume
Violet
Moderately obesity
Mild hypertension
Come 8 weeks check, what asesment?
Diet
Lab work for liver and kidney function baseline
Possible 24-hour urine
What risk factors does Violet
have for pregnancy complications?
35-year-old
Moderately obesity
Mild hypertension
first pregnancy
Chronic hypertension
Obesity
Sedentary lifestyle 座りっぱなし
Advance Maternal Age (AMA)
First pregnancy
Violet comes into the office at 32 weeks
B/P sitting is 144/96
35-year-old
Moderately obesity
Mild hypertension
first pregnancy
What subjective date need?
Mom tells you!
vision changes
Edema of her hands and legs
Epigastric pain
Nausea and vomiting
Fetal movement
Violet comes into the office at 32 weeks
B/P sitting is 144/96
35-year-old
Moderately obesity
Mild hypertension
first pregnancy
What objective date need?
Urine for protein
Clonus
Fetal growth
NST
Dr’s order bed rest, why??
Lateral position inc perfusion to the
mother’s kidneys and the placenta.
It does not cure, but it gives the baby more time to reach maturity.
Education for collecting the 24-
hour urine
Starts with first void in the toilet
All urine must be collected
Ends with final void collected exactly when the 24 hours is complete. Specimen should be kept cold
Violet is developing Preeclampsia
What’s choice she must take?
Delivery now
Preeclampsia can only be cured with delivery.
What are some indications that the preeclampsia is worsening?
Inc BP
Dec platelets
Inc liver enzymes
Pulmonary edema
Dec perfusion to the fetus
Abruptio placenta due to hypertension
a) G2P1 who delivered her first baby at 28 weeks
She wants to know how to prevent this baby from coming early
b) When would it have been ideal for Holly to ask this question?
a)
Assess any risk factors present with her first delivery that can be modified
* Smoking/substance abuse
* Infection
* Stress
* Obesity/low maternal weigh
* Nutrition/anemia
* Spacing of pregnancies
* Dental issues
b)
Prior to this pregnancy
Signs leads to premature Labor to
call to provider
Uterine cramping
Contractions every 10 mins or more in
frequency
Vaginal bleeding
Vaginal leaking
Persistent Low back pain
Pelvic pressure
Prioritize Orders
Dx: preterm labor
2nd Trimester complications
How is Cervical Insufficiency different from Preterm labor?
Painless
Inc vaginal discharge
Pelvic pressure
PTL doesn’t have to occur to PTD, why?
Because they don’t have choice, they need to deliver the baby
-Placenta previa
-Preeclampsia
-IUGR
PPROM
If contraction present
What we need to do?
1 Stop the insult!!!!
Try to stop or at least dec constriction
-Magnesium Sulfate
Relax smooth muscle
Betamethasone
For lung maturity
DM Type 2 woman need to switch
oral med to insulin BEFORE pregnant, why?
Because they cannot take oral meds during pregnant(cross placenta)
Insulin doesn’t cross placenta
Preeclampsia
Characteristics
2nd maternal death after deliver
Pregnancy is the cause
Deliver is the cure
First mom is at risk
But yet 25% is still develops
Preeclampsia
Symptoms
Dec perfusion to all organs
Protein leaks cause swollen all over the body
Dehydration
Relationship perfusion and Urine out put
a) Good perfusion what?
b) Bad perfusion what?
a) Inc urine out put
b) Dec urine out put
Signs of Magnesium toxicity?
Extreme caution for overdose
lead to resp distress/
-Monitor respiratory rate
Need to understand to administer magnesium sulfate
Dec BP due to vasodilation
But we give it to prevent seizures
Inc risk for falls!!!
Dec u/o inc the risk for toxicity
Make sure that the pt makes pee!!!
Magnesium and preeclampsia
Teaching
Expect hot flushing sensations with the bolus of magnesium
Drowsiness and muscle weakness
Vital signs will be assessed hourly as well as lung sounds, u/o
An indwelling catheter will be necessary for strict I&O
Maintain bedrest
NPO or limited to ice chips
Visitors will be limited
What is a nursing goal for diabetes?
FBS range?
2hr postprandial range?
FBS <95
2hr postprandial <120
Differences
a) PROM?
b) PPROM?
a) spontaneous rupture >37 weeks
Rupture prior to contraction
b) premature spontaneous rupture
< 37weeks
PROM
Risk factors Mom
Infection
Abruptio placenta
Hemorrhage
Maternal sepsis
death
PROM
Risk factors baby
Prolapsed cord
Fetal sepsis
Dec placenta perfusion
PPROM
a) Risk factors Mom
a) infection
b) Prolapsed cord
Respiratory distress
Premature birth
Tachycardia
