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Undeleted > Complications > Flashcards

Complications Flashcards

0
Q

Risk Factors associated with Pre-term Labor

A

Previous pre-term Labor, genetics, cervical and uterine trauma, infections, PPROM, Maternal age 35 yrs, tobacco and cocaine use, hypertension

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1
Q

Preterm Labor

A

Labor that occurs between 20 to 36 weeks

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2
Q

Fetal and Placental Cause of PTL

A

Multiple Gestation, Twins, hydramnous, placental ischemia, previa, and abruptio

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3
Q

Management of PTL

A

Fetal Fibronetic test viable between 24 to 34 weeks. If negative -> low risk of PTL up to 14 days. If positive -> higher risk of PTL within 7 days
Administer tocolytic if 32 to 34 weeks to delay labor and relaxes smooth uterine muscle
Administer corticosteroid to increase maturity of lungs if under 34weeks
Progesterone therapy

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4
Q

Nursing care for PTL

A
  • Monitor uterine contractions and PV loss
  • Monitor fetus
  • prepare for preterm birth if contraction continues
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5
Q

Post Term Labor

A

-Any labor that occurs after 42 weeks

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6
Q

Causes of Post Term Labor

A

-usually error in determining ovulation and conception

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7
Q

Data for Post term labor

A

Weight loss, decrease in fetal movement

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8
Q

Maternal Risk Associated with Post Term Labor

A
  • increase psychological stress, induction, dystocia, assisted delivery
  • perineal trauma, increased laceration, risk for bleeding and infections
  • increase caesaren - increase DVT
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9
Q

Risk Associated for Fetus in Post Term Labor

A

-decrease placental perfusion, fetal demise, oligohydramious, macrosomia, low abgar score, SIDS, nerve and bone damage ->paralysis, cerebral palsy, meconium aspiration

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10
Q

Medical Intervention for Post-Term Labor

A
  • at 41 weeks daily fetal movement count
  • nonstress test (NST) 2/week
  • U/S for fetal size
  • Amniotic fluid index (AFI) 2/week
  • Elective induction if viable
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11
Q

Precipitous Labor and Delivery

A

Labor - any labor that last for less than 3 hours

Delivery - any birth that is unplanned, sudden, or unexpected

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12
Q

Factors Associated with Precipitous Labor

A

-multiparity, small fetus, large pelvis, previous precipitous labor

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13
Q

Maternal Risk for Precipitous Labor

A

-increase laceration and trauma, decreased coping abilities, PPH

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14
Q

Fetal Risk Associated with Precipitous Labor

A

-hypoxia, fetal distress caused by intense uterine contraction, bracial nerve injury

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15
Q

Induction

A

the artificial initiation of uterine contraction, resulting in the birth of a baby

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16
Q

Maternal Condition Indication of Induction

A

-Post term Labor, diabetes, renal disease, PROM, chorionamnionitis, previous precipitous labor

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17
Q

Fetal Condition for Induction

A
  • intrauterine fetal growth restriction (IUGR)
  • Fetal demise
  • Macrosomia
  • HYMOLYTIC DISEASE
  • mild abuptio
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18
Q

Management of Induction

A

Unripe Cervix - (6 on Bishop score)

-sweep membrane, amniotomy, prostaglandin gel intravaginal, IV oxytocin

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19
Q

Nursing care for Induction

A

V/S, Leopold’s Maneuver, vaginal exam, EFM
RN to follow induction protocol
PT and Fetus monitor q2h
-if cervidil or prostaglandin - pt may be sent home until active labor

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20
Q

Forcep and Vacuum Extraction Maternal and fetal Indication

A
  • exhaustion, lack of progress, health condition (heart disease and PIH), decrease motor innervation from epidural
  • fetal distress, placenta seperation, OP position, macrosomia, breech
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21
Q

Maternal Risk and Fetal risk for Forceps and Vacuum

A

Maternal: increase laceration and trauma, increased bleeding, infection and hemorrhage

Fetus: decrease flexion of head, echymosis, edmema, caput, cephalohematoma, paralysis

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22
Q

Fetal Distress Causes

A

-cord compression, placenta insufficiency, maternal, fetal and placenta disease

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23
Q

Fetal Distress Warning Signs

A
  • meconium stained liquoi, omnious FHR patterns

- CODE OB

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24
Q

Nursing Intervention for Fetal Distress

A

-give O2, tilt uterus on left side, EFM, internal monitoring, D/C induction, give tocolytic, I/V, fetal scalp blood sample

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25
Q

Prolapsed Cord

A

-cord that descends through the vagina prior to birth of baby

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26
Q

Risk factors Associated with Prolapsed Cord

A

-breech, polyhydramnious

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27
Q

OB EMERGENCY OF Prolapsed CORD

A

-Knee to chest (mcroberts maneuver), hand in vagina to relieve pressure off the cord

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28
Q

Shoulder Dystocia

A

-after delivery of head further expulsion of infant is prevented due to impaction of fetal shoulders in the maternal pelvis

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29
Q

causes of Shoulder Dystocia

A

-Macrosomia, maternal diabetes, obesity, multiparity, post term

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30
Q

What to do when there is Shoulder Dystocia

A

alert ALARMER

  • Ask for help
  • Lift hips/hyperflex of hips
  • Anterior shoulder disimpaction
  • Rotation of the posterior shoulders
  • Manual removal of posterior shoulders
  • Episiotomy
  • Roll women on all fours
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31
Q

Maternal and Fetal complications of Shoulder Dystocia

A

PPH, Trauma, and infection

  • Brachial plexus injury
  • fractures, asphyxia, neurological damage, demise
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32
Q

DVT Associated factors

A

-hydramnious, preeclampsia, operative birth, history of clots, obesity

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33
Q

DATA involving DVT

A

-color, warmth, movement, sensation, edema, low grade fever

34
Q

TX for DVT

A

Prevention - ambulate early, no crossing legs

-heparin, increase fluids

35
Q

Inversion of Uterus Prevention and TX

A

Prevented by

  • waiting for signs of separation
  • cord extending, gush of blood
  • no fundal pressure

TX
-put back in, call MD

36
Q

Hyperemsis Gravidarium

A

-excessive and persistent nausea and vomiting during pregnancy associated with ketosis and weight loss

37
Q

HG causes

A
  • increase HCG and TSH in the first trimester, increase estradiol and decrease in prolactin
  • genetic
38
Q

Objective and subjective DATA for HG

A
  • progressive vomiting and retching
  • dehydration
  • fluid and electrolytes imbalance
  • hypotension, tachycardia
  • K+ loss
  • Fetal loss
39
Q

TX for HG

A 
Assess physical and emotion state
NPOx48H
Monitor I&O
antiemetic
correct F&E imbalance
TPN PRN
control environment
40
Q

Spontaneous Abortion

A

-spontaneous loss of pregnancy prior to viability (20 weeks)

41
Q

Types of SA

A

Threatened - bleeding, cramping, closed cervix
Imminent/inevitable - bleeding, cramping, dilation of cervix
incomplete - not all expelled, placenta retained
complete - all product expelled
Miss Abortion - fetus dies, brownish discharge, risk of DIC if not expelled
Recurrent pregnancy loss
Septic abortion - presence of infection

42
Q

Causes of SA

A 
Chromosomal and placental abnormalities
implantation problems
teratogens (hot tubs)
endocrine imbalance
infections
43
Q

Data for SA

A

Spotting, cramping, backaches

44
Q

TX for SA

A 
Determine source of blood
cross match blood, HBG, HCT
bed rest
no sex
If imminent -> hospitalize -> IV, suction
emotional support
45
Q

Placenta Previo

A

low implantation of the placenta

46
Q

Types of Previo

A

Low lying - lower segment
Marginal - on the margin of the internal OS
Partial - partially covering the internal OS
complete - completely covering the internal OS

47
Q

Causes for Previa

A

Multiparity, previous c-sec, previous induced abortion, age, large placenta, smoking, asian women

48
Q

Data for Previa

A

U/S

Bleeding abruptly, painless, bright red

49
Q

TX for Previa

A 
Bed rest, BR only privilege, side lying, oxygen PRN 
FHR
VS U/S
HBG and HCT, cross match  and urinalysis 
Delay birth until 37 weeks
administer corticosteroids
C-sec if complete previa
Vag delivery if low lying or marginal
50
Q

Placenta Abruption

A

Premature separation of the normally implanted placenta from the wall of the uterus

51
Q

Types of Abruption

A

Marginal, Control, Complete
Grade 1 - Mild separation (mild bleeding, stable V/S and FHR)
Grade 2 - partial separation (uterine irritability)
Grade 3 - Complete (fetal death)

52
Q

Causes of Abruption

A 
increase age, multi parity 
PIH, trauma, sudden uterine pressure change
previous abruption
cocaine and smoking
PPROM
53
Q

Data for Placenta Abruption

A 
Pain (sharp, stabbing, high in fundal area)
bleeding (only marginal) overt
Covert - uterine becomes hard (central)
Shock
DIC
54
Q

TX for Abruption

A 
IV 
Monitor V/S of PT and Fetal
PV loss
contraction
O2
Stat blood work, HBG, HCT, Cross match, Fibrogen levels
-ARM & Induction , Vacuum
55
Q

Cervical Insufficiency

A

Cervix dilates early and cannot hold a fetus to term

painless dilations occurring between 4th to 5th month

56
Q

Cause and types of Cervical Insufficiency

A

Congenital
acquired (infection, trauma, multiple gestations)
Biochemical (relaxin)

57
Q

Objective & Subjective data of CI

A

Painless dilation of cervix
Increased pelvic pressure
contraction
birth of premature baby

58
Q

Medical treatment and Nursing care for CI

A

Vaginal U/S @ 15 to 28 weeks
bed rest, no sex, heavy lifting
Cerclage/suture @ 14 to 18 weeks
progesterone, anti-inflammatories, antibiotics

59
Q

Hypertensive Disorders in pregnancy

A

Preeclampsia (mild to severe) is the increase of BP after 10 weeks gestation accompanied by proteinuria in a previously normaltensive women
Eclampsia - severe form of preeclampsia with generalized edema or coma

60
Q

Predisposing Factors of Hypertensive orders in preg

A 
Teens and older primips
previous history
large placental mass
Rh incompatibility
diabetes
61
Q

Objective and Subjective DATA for Preeclampsia and Eclampsia

A

mild disease - 140/90 4 hours apart, Proteinuria +1-+2
edema >3.3/month

Severe preeclampsia - 160/110, 6 hours apart, proteinuria +3 to +4

-oliguria, visual or cerebral disturbances, cyanosis/pulmonary and generalized edema

62
Q

TX of Preeclampsia and Eclampsia

A

Freq assessment of VS, I&O, FH, Uterus, PV loss, edema, weight, reflexes, signs of eclampsia, LOC and psychosocial

  • bed rest (left side) & diet
  • anticonvulsant, antihypertensive, corticosteroids
  • lab test (Hct, BUN, creatinine, uric acid levels, liver enzymes, F&E imbalances and MG levels
63
Q

TX for Severe PIH

A

stabilize then deliver baby by induction or C-sec

64
Q

HELLP SYNDROME

A

hemolysis, elevated liver enzymes, low platelet count

- sometimes associated with severe preeclampsia

65
Q

DIC - Disseminated intravascular coagulation associated with

A

preeclampsia, eclampsia, HELLP (occur as complication)

  • placenta abruptio
  • amniotic fluid embolism
  • maternal liver disease
  • septic abortion
  • dead fetus
66
Q

Diabetes Mellitus S&S

A

Polyuria
polydipsia
polyphagia
wt.loss

67
Q

Rh Alloimmunization

A
  • Rh+ cells invade maternal circulation and stimulate production of antibodies
  • produced in 72hours
  • if antibodies are formed, future pregnancies the antibody will cross placenta barrier and hemolyse fetal RBC’s
68
Q

Rh Isoimmunization TX and Nursing CARE

A

-early testing
If Rh-, indirect coombs done (determine the presence and amt of antibodies

  • AntiD or Rhogam given at 28weeks if no antibodies present
  • if at birth, mom is Rh neg, direct coomb’s test on cord’s blood
  • if negative, mom will receive anti D in 72 hours of birth

Rh immunoglobulin not given if mom is Rh positive

69
Q

ABO Incompatibility

A

Mother O (no antigenic sites on RBC), Baby A, B, AB (may be affected

  • become aware in preg
  • monitor baby for jaundixe
  • phototherapy PRN
70
Q

Premature Rupture of Membranes PROM

A

PROM before onset of labor

71
Q

Risk associated with PROM

A

Smoking, low BMI, infections, history of PROM, incompetent cervix, trauma, hydramnious, multiple gestation, previa/abruptio

Risks - infection (chorioamnionitis, endometritis), Abruptio

Fetal - premature birth, neonatal sepsis, cord prolapse

72
Q

Diagnose for PROM and TX

A

Nitrazine test
fern test

TX

  • avoid vag exam unless in active labor
  • if less than 37 weeks, bedrest, CBC, weekly NST, V/S q4h, antibiotics, betamethasone, no sex and baths
  • if >37 induce delivery
73
Q

What is Ectopic Pregnancy

A

-implantation of the fertilized ovum in a site other than the endometrial lining of the uterus

74
Q

Causes of Ectopic Pregnancy

A
  • pelvic inflammatory disease
  • endometriosis
  • previous ectopic pregnancy
  • presence of IUD
75
Q

Diagnose of Ectopic Pregnancy

A
  • Assess menstrual history

- careful pelvic exam to identify any abnormal pelvic masses or tenderness

76
Q

Treatments for EP

A
  • methotrexate is given if detected early with low Hcg level

- surgically to remove by the process of salpingostomy to gently remove

77
Q

Objective and subjective data for Ectopic Pregnancy

A
  • acute pain related to abdominal bleeding
  • shoulder pain
  • vaginal bleeding
78
Q

Nursing care for EP

A
  • If using methotrexate, no sun exposure

- Start IV, assess for shock/bleeding, assess pain level

79
Q

Hydatidiform mole

A

disease in which abnormal development of placenta occurs, resulting in a fluid filled grape like clusters; the trophoblastic tissue proliferates

80
Q

Types of Hydatidiform Mole

A

Complete Mole is when an ovum containing no maternal genetic material fertilizes with a sperm.
Partial Mole is when an ovum fertilizes with a sperm in which contains 46 chromosome

81
Q

Subjective and Objective data for HM

A
  • brownish vaginal bleeding
  • uterine enlargement is greater than the expected gestation week is common in complete HM
  • vesicles may be passed
  • Hyperemesis gravidarium
  • symptoms of preeclampsia before week 24
  • no FH or movement
82
Q

Treatment for HM

A
  • suction to remove all fragments

- hysterectomy to reduce risk of choriocarcinoma

83
Q

Nursing Care for HM

A
  • assess emotional support
  • VS
  • vaginal bleeding for hemorrhage
  • assess pain
  • blood work Hct, cross match
  • oxytocin is given to keep uterus contracted
  • Rh immunity is given if women is Rh-

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