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Obstetrical nursing > complications during pregnancy and assessment of fetal well being > Flashcards

complications during pregnancy and assessment of fetal well being Flashcards

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1
Q

spontaneous abortion- sab

A

when a pregnancy ends as the result of natural causes before 20 weeks of gestation

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2
Q

risk factors for sab

A

Chromosomal abnormalities, expectant illness (DM- not well controled), AMA, premature cervical dilation, infection, trauma, substance use, antiphospholipid syndrome

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3
Q

s/s of sab

A

lower Abd pain/cramping, ROM (leakign fluid), cervical dilation, fever, s/s hemorrhage

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4
Q

AMA

A

advanced maternal age >35

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5
Q

ROM

A

rupture of membranes

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6
Q

s/s of hemmorage

A

hard abd, low bp, increase hr, rr increase, diaphoertic, weak, dizziness, pale faint

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7
Q

ectopic prgen

A

The abnormal implantation of a fertilized ovum outside the uterine cavity, usually in the fallopian tube

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8
Q

ectopic preg risk factors

A

Tubal issues r/t STIs, assisted reproductive tech, surgery, IUDs

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9
Q

ectopic preg s/s

A

unilat lower abd pain/tenderness, missed period, vaginal spotting/bright red bleeding (if tube ruptured), referred shoulder pain (tubal rupture), hemorrhage/hypotensive shock

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10
Q

s/s of abd tubal rupture

A

rigid
rounded
bruising along umblilicord

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11
Q

SAB testing

A

H+H, Clotting factors, WBC, serum HCG, ultrasound, Vag speculum

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12
Q

sab procedure

A

Dilitation and curettage (D+C), Dilitation and evaculation (D+E), induction of labor

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13
Q

sab nurisng implications

A
  • Assist with testing/procedures
  • Avoid vaginal exams
  • Monitor bleeding, vitals/assessment for hemorrhage
  • Provide education and emotional support, refer to pregnancy loss support group
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14
Q

ectopic testing

A

Serum levels of progesterone and HCG to help determine pregnancy

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15
Q

ectopic procedures

A

Transvag ultrasound to confirm empty uterus, possible need for salpingostomy/laparoscopic salpingectomy (removal of tube/products of conception)

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16
Q

ectopic nursing implications

A
  • May need to give methotrexate to dissolve pregnancy (stops cells from diving)
  • obtain CBC, HCG levels, Liver enzymes, blood T+C
  • replace fluids and maintain electrolytes,
  • lots of client education, emotional care and support
  • Refer to pregnancy loss support group
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17
Q

Hyperemesis Gravidarum

what does it cause

A

Excessive nausea and vomiting that is prolonged past 16 weeks that causes weight loss, dehydration, nutritional deficiencies, electrolyte imbalances, and ketonuria

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18
Q

gtd

A

gestational trophoblastic disease

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19
Q

risk factors of HG to fetus

A

intrauterine growth restriction, small of gestational age, or preterm birth

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20
Q

risk factors for HG

A

Expectant age <30, multifetal gestation, GTD, psychosocial issues r/t emotional stress, hyperthyroid disorders, diabetes, GI disorders, Family Hx, migranes

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21
Q

HIV/ AIDS meds

A
  • antiretroviral therapy (ART)

- highly active antiretroviral therapy (HAART)

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22
Q

antiretroviral therapy

A

Orally throughout pregnancy and before onset of labor

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23
Q

Highly active antiretroviral therapy (HAART)

A
  • Intrapartum- IV zidovudine 3 hr prior to C/S until birth

- Infant gets zidovudine at delivery and for 6 weeks following birth

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24
Q

HIV aids nursing care

A
  • Goal is to keep CD4 count >500 cells/mm
  • Encourage immunizations
  • Planned C/S at 38 weeks for viral load for more than 1,000 copies/ml at 36 weeks
  • Vaginal birth can be an option for viral load of less than 1,000 copies/ml at 36 weeks
  • Infant should be bathed right after birth/skin to skin
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25
Q

c section w HIV

A

38 weeks for viral load for more than 1,000 copies/ml at 36 weeks

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26
Q

vagina birth for HIV

A

viral load of less than 1,000 copies/ml at 36 weeks

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27
Q

client teaching for HIV

A
  • Discuss HIV and safe sex practices
  • Do not breastfeed (developed nations)!
  • See immunologist for HIV care/treatment
  • HIV is a reportable disease, counsel client on mandatory reporting to health department
28
Q

Placenta Previa

A

When the placenta implants in the lower uterine segment near or over the cervical os

29
Q

Placenta Previa clinical manifestations

A
  • **Painless, bright red vag bleeding in 2nd or 3rd trimester
  • Uterus soft/non-tender
  • Greater fundal height compared to gest age
  • Fetus breech, oblique, or transverse lie
  • ***Reassuring FHTs
  • Vitals WNL
30
Q

placenta abruption

A

The premature separation of the placenta from the uterus after 20 weeks, which can be a partial or complete detachment. High risk for expectant or fetal morbidity and mortality

31
Q

placenta abruption risk factors

A

Pre- eclampsia, abd trauma (MVC or battery), cocaine use, smoking, premature rupture of membranes, multifetal pregnancy

32
Q

placenta abruption clinical manifestations

A
  • **Sudden onset of intense localized uterine pain with dark red vag bleeding
  • ***Abd rigid and very tender
  • Freq intense hypertonic contractions
  • ***Fetal distress
  • S/S of hypovolemic shock
33
Q

GDM antepartum interventions

A
  1. Diet
  2. Exercise
  • Monitoring blood glucose (fasting, 1 -2 hour postparandial: after first bite of food)
  • Pharmacologic therapy: Insulin vs. oral hypoglycemics (Metformin or Glyburide)
  • Fetal surveillance: DFMC, NST, assessing for degree of macrosomia
33
Q

GDM intrapartum interventions

A

Glucose monitoring hourly: 80-110 mg/dl desired
Insulin infusion may be needed to maintain Bld. glucose levels
Avoid dextrose solutions

34
Q

GDM after birth interventions

A 
Most return to normal
High risk for future GDM in pregnancy
Increased risk of type 2 diabetes esp. with decreased exercise and diet control
Reassess at 6-12 weeks PP
Contraceptives: low dose OCPs or IUDs
35
Q

hypertensive clinical manifestations

A
  • Hypertension (140/90)
  • Proteinuria
  • Periorbital, facial, hand, abd edema, sacral edema
  • Pitting edema
  • Hyperreflexia:test deep tendon reflexes 3+
  • Scotoma
  • Epigastric pain
  • RUQ pain
  • Dyspnea
  • Seizures
36
Q

elevated labs for hypertensive

A

Elevated Liver Enzymes, increased protein- creatinine ratio, thrombocytopenia, lower Hgb, Increase bilirubin

37
Q

preteinuria in hypertensive

A

Diagnosis: Dipstick for proteinurea or 24 hour urine collection for protein.

Significant proteinuria is defined as ≥0.3 g in a 24-hour urine specimen or protein/creatinine ratio ≥0.3 (mg/mg) (30 mg/mmol) in a random urine specimen or dipstick ≥1+ if a quantitative measurement is unavailable.

38
Q

antihypertensive

A

Methyldopa (PO)
Nifedipine (PO)
Hydralazine (IV)
Labetalol (PO or IV)

39
Q

client education for antihypertensive

A

Avoid ACE inhibitors or ARBs with the above meds

40
Q

magnesium sulfate

A

Used as an anticonvulsant- to depress the CNS and prevent seizures in severe Pre-E or Eclampsia

41
Q

magnesium sulfate dosage

A

Loading dose 4-6g IV over 20 min, Maintenance dose: 1-2 g continuous IV

42
Q

3 reason to use MS

A
  • seizure precautions
  • uterine relaxed
  • neuro protection
43
Q

what to closely motior for MS

A

Vitals, LOC, headache, blurred vision, epigastric pain, DTRs, urine output via strict I+O, Mag level 5-8 mg/dL, UCs, FHTs

44
Q

toxicity s/s for MS

A 
Loss of DTR
Urine output less than 30ml/hr
********Resps less than 12/min
Decreased LOC
Cardia dysrhythmias
45
Q

normal s/s for MS

A

-Normal to feel flushed, hot, weak (like a wet, hot, noodle), may have burning at IV site

46
Q

ms toxicity interventions

A

Stop Infusion!
Support ABCs
Administer antidote: Calcium Gluconate – 10mg IV over 10 min

47
Q

hypertensive disorders in preg.. pt. .education

A
  • Remain on bedrest if at home with expectant management
  • Keep yourself distracted while on bedrest
  • Avoid foods high in sodium
  • Avoid alcohol and tobacco, limit caffeine intake
  • Drink 6-8 glasses of water/day
  • Keep a quiet environment, decrease stimuli
  • Have family call 911 if you experience a seizure (they should roll you on your side and try to keep your airway clear)
  • Take your antihypertensive meds as prescribed
48
Q

preterm labor nursing implications

A

Activity Restriction
- Bedrest w BR privileges, lay on side

Ensuring hydration
- Prevents release of oxytocin which stimulates UCs

Identifying and treating infections
- Monitor temps and s/s of infection

Monitor FHT and contractions

Fetal tachycardia
- > 160/min can indicate infection

49
Q

nifedipine

A

calcium channel blocker

Monitor for s/s of hypotension
Educate about s/s of hypotension

50
Q

magesium

A

same dosage / info as in Pre-E

Monitor pt closely, look for s/s of toxicity

51
Q

terbutaline

A

tocolytic (stops uterine contractions)

Can cause tachycardia (should not be given to pts with cardiac hx)

52
Q

indomethacin

A

NSAID (blocks production of prostaglandins)

Shouldn’t be given after 32 weeks (premature closure of ductus arteriosus

53
Q

for fetus: betamethasone

A
  • for fetal lung maturity
  • first dose: 12 mg IM initially
  • 2nd dose: 12mg Im 2hr after 1st
  • “window” 48 hr after initial dose
54
Q

Amniocentesis

A

(aspiration of amniotic fluid by insertion of needle transabdominally)

55
Q

Amniocentesis weeks gestation

A

After 14 weeks

(between 15- 20 weeks)

56
Q

Amniocentesis interpretation of findings

A
  • Presence of Alpha fetaloprotein could mean chromosomal anomaly or neural tube defect
  • Can also test fetal lung maturity
  • Fetal hemolytic disease
57
Q

Maternal Alpha Fetoprotein

A

blood test

58
Q

Maternal Alpha Fetoprotein weeks

A

16-18

59
Q

Maternal Alpha Fetoprotein interpretation of findings

A

High levels- neural tube defect or open abd defect
Low levels- down syndrome
Screening tool- further test needed if positive

60
Q

nonstress test

A

Non invasive fetal monitoring with external doppler transducer (for FHT) and tocotransducer (for contractions)

61
Q

nonstress test reactive NST

A
  • Fetal heart rate normal at 110- 160/min
  • Moderate variability (fluctuation in HR by 6-25 beats)
  • Fetal heart rate accelerates at least 15/min for at least 15 seconds
    (>32 weeks), 10/min for at least 10 seconds for <32 weekers
  • Two accelerations in a 20 minute period
  • No decelerations
62
Q

nonstress test nonreactive NST

A

Anything above is not met in 40 min

BPP needed

63
Q

Biophysical Profile (BPP)

A

Ultrasound to visualize physical and physiological characteristics of the fetus and observe for responses to stimuli

64
Q

Biophysical Profile (BPP) test for

A

FHR (fetal heart rate)
Reactive nonstress test (NST

Fetal breathing movements
At least 1 episode of greater than 30 seconds duration in 30 min

Gross body movements
At least 3 body or limb extensions with return to flexion in 30 min

Fetal Tone
At least 1 episode of extension with return to flexion

Qualitative amniotic fluid volume
At least 1 pocket of fluid that measures at last 2 cm in 2 perpendicular planes=

Obstetrical nursing (8 decks)

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