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Maternal Newborn > Complicated pregnancy PPT > Flashcards

Complicated pregnancy PPT Flashcards

1
Q

1st Trimester
Mom’s risk 2

A

Spontaneous abortion
Ectopic pregnancy
GTD
Infection
-UTI
-Vaginal discharge

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2
Q

1st Trimester infection
UTI
expecting finds

A

Burning with urination
Fever
Severe back pain

Call for early signs of UTI

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3
Q

1st Trimester infection
Vaginal discharge

A

Heavy white discharge
Fishy odor

Indicate yeast or Bacterial vaginosis

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4
Q

1st Trimester infection
Prevention
Infections during pregnancy

A

Hand washing, hand sanitizer
Condom use
Avoiding sick people

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5
Q

Infections that harm the fetus 4

A

Gonorrhea and Chlamydia
Syphilis
Group B Strep

TORCH
Toxoplasmosis
Other infections
Rubella
Cytomegalovirus
HSV

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6
Q

What is STI?
What is STD?

A

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.

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7
Q

Gonorrhea and Chlamydia
Characteristics

A

STI
Chlamydia is most common STI
Reportable diseases

If it untreated, it can lead to pelvic inflammatory disease (PID)

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8
Q

Gonorrhea and Chlamydia
Treatment

A

Should be treated if diagnosed and all neonates should receive erythromycin ointment in the eye

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9
Q

Syphilis
Characteristics

A

STI
3 stages
Report disease

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10
Q

Syphilis
Test how and when?

A

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

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11
Q

Group B Strep
Characteristics

A

Can pass go a fetus during labor and delivery
Vaginal flora infection is NOT STI

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12
Q

Group B Strep
Treatment

A

Women should be screened

Administered during labor
Penicillin G
Ampicillin

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13
Q

TORCH
Characteristics

A

These infections cross the placenta
Teratogenic effects of the fetus Treatment depends on the infection

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14
Q

Treatment
a)Toxoplasmosis
b) Rubella
c) Cytomegalovirus

A

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

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15
Q

1st Trimester
2nd?
3rd?

A

1st till week 12
2nd week 13 to 26
3rd week 27 to the end

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16
Q

1st Trimester complications
Herpes Simplex
a) How to transmit?
b) Medication

A

a)
through the placenta
Usually transmitted during vaginal delivery
b)
acyclovir
Not guarantee viral transmission will not occur at birth

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17
Q

1st Trimester complications
HIV
a) When it transmits?
b) Treatment

A

a)
through the placenta
during delivery
b)
Antiretroviral therapy
but does not guarantee viral transmission will not occur

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18
Q

1st Trimester complications
HIV
What test should avoid?

A

amniocentesis
placement of internal monitors
episiotomies

After birth neonatal injections should be withheld until after the first bath is given

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19
Q

Amniocentesis?

A

between the 15th and 20th weeks
at greater risk for birth defects

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20
Q

Episiotomies?

A

A cut (incision) made in the tissue between the vaginal opening and the anus during childbirth

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21
Q

Warning Signs
1st trimester

A

Bleeding
Infection >100.4
Vomiting
Abdominal pain

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22
Q

Warning Signs 1st trimester
What waring sing
Bleeding
Abdominal pain

A

Abortion
Ectopic
Placenta previa
Hydatidiform mole

Hydatidiform mole
A noncancerous tumor that develops in the uterus

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23
Q

Warning Signs 1st trimester
What waring sing
Vomiting how to asses?

A

greater than twice a day
severe nausea

enough to prevent eating and drinking.
Assess amount of vomiting, weight loss, electrolyte imbalance.

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24
Q

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

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

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25
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
26
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
27
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
28
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
29
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
30
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
31
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
32
Type 2 diabetes Risk for during pregnancy
Hydramnios Preterm delivery Preeclampsia Hyperglycemia UTIs, yeast infections Poor wound healing Difficult labor
33
Hydramnios?
A condition that occurs when too much amniotic fluid builds up during pregnancy
34
Preeclampsia?
High blood pressure (hypertension) disorder that can occur during pregnancy.
35
Macrosomia?
Growth beyond a specific threshold Weight above 4500 g
36
Type 2 diabetes Risk for during pregnancy Vascular damage
SGA IUGR Require early delivery r/t inadequate perfusion.
37
SGA?
Small for gestational age A baby who is smaller than the usual amount for the number of weeks of pregnancy
38
IUGR
Intrauterine growth restriction A condition in which a baby doesn't grow to normal weight during pregnancy
39
Type 2 diabetes Risk for during pregnancy BG is not well controlled
fetal anomalies -especially cardiac defect poor perfusion!!
40
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
41
DM Type 1 Expecting findings
Wt loss is from too little insulin Dehydration Proteinuria Dec BP r/t dec fluid volume
42
Violet Moderately obesity Mild hypertension Come 8 weeks check, what asesment?
Diet Lab work for liver and kidney function baseline Possible 24-hour urine
43
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
44
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
45
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
46
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.
47
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
48
Violet is developing Preeclampsia What's choice she must take?
Delivery now Preeclampsia can only be cured with delivery.
49
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
50
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
51
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
52
Prioritize Orders Dx: preterm labor
53
2nd Trimester complications How is Cervical Insufficiency different from Preterm labor?
Painless Inc vaginal discharge Pelvic pressure
54
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
55
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 #2 Protect baby Betamethasone For lung maturity
56
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
57
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
58
Preeclampsia Symptoms
Dec perfusion to all organs Protein leaks cause swollen all over the body Dehydration
59
Relationship perfusion and Urine out put a) Good perfusion what? b) Bad perfusion what?
a) Inc urine out put b) Dec urine out put
60
Signs of Magnesium toxicity?
Extreme caution for overdose lead to resp distress/ -Monitor respiratory rate
61
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!!!
62
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
63
What is a nursing goal for diabetes? FBS range? 2hr postprandial range?
FBS <95 2hr postprandial <120
64
Differences a) PROM? b) PPROM?
a) spontaneous rupture >37 weeks Rupture prior to contraction b) premature spontaneous rupture < 37weeks
65
PROM Risk factors Mom
Infection Abruptio placenta Hemorrhage Maternal sepsis death
66
PROM Risk factors baby
Prolapsed cord Fetal sepsis Dec placenta perfusion
67
PPROM a) Risk factors Mom
a) infection b) Prolapsed cord Respiratory distress Premature birth Tachycardia

Maternal Newborn (20 decks)

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