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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

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
c section w HIV
38 weeks for viral load for more than 1,000 copies/ml at 36 weeks
26
vagina birth for HIV
viral load of less than 1,000 copies/ml at 36 weeks
27
client teaching for HIV
- 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
Placenta Previa
When the placenta implants in the lower uterine segment near or over the cervical os
29
Placenta Previa clinical manifestations
* **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
placenta abruption
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
placenta abruption risk factors
Pre- eclampsia, abd trauma (MVC or battery), cocaine use, smoking, premature rupture of membranes, multifetal pregnancy
32
placenta abruption clinical manifestations
* **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
GDM antepartum interventions
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
GDM intrapartum interventions
Glucose monitoring hourly: 80-110 mg/dl desired Insulin infusion may be needed to maintain Bld. glucose levels Avoid dextrose solutions
34
GDM after birth interventions
``` 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
hypertensive clinical manifestations
- 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
elevated labs for hypertensive
Elevated Liver Enzymes, increased protein- creatinine ratio, thrombocytopenia, lower Hgb, Increase bilirubin
37
preteinuria in hypertensive
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
antihypertensive
Methyldopa (PO) Nifedipine (PO) Hydralazine (IV) Labetalol (PO or IV)
39
client education for antihypertensive
Avoid ACE inhibitors or ARBs with the above meds
40
magnesium sulfate
Used as an anticonvulsant- to depress the CNS and prevent seizures in severe Pre-E or Eclampsia
41
magnesium sulfate dosage
Loading dose 4-6g IV over 20 min, Maintenance dose: 1-2 g continuous IV
42
3 reason to use MS
- seizure precautions - uterine relaxed - neuro protection
43
what to closely motior for MS
Vitals, LOC, headache, blurred vision, epigastric pain, DTRs, urine output via strict I+O, Mag level 5-8 mg/dL, UCs, FHTs
44
toxicity s/s for MS
``` Loss of DTR Urine output less than 30ml/hr ********Resps less than 12/min Decreased LOC Cardia dysrhythmias ```
45
normal s/s for MS
-Normal to feel flushed, hot, weak (like a wet, hot, noodle), may have burning at IV site
46
ms toxicity interventions
Stop Infusion! Support ABCs Administer antidote: Calcium Gluconate – 10mg IV over 10 min
47
hypertensive disorders in preg.. pt. .education
- 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
preterm labor nursing implications
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
nifedipine
calcium channel blocker Monitor for s/s of hypotension Educate about s/s of hypotension
50
magesium
same dosage / info as in Pre-E Monitor pt closely, look for s/s of toxicity
51
terbutaline
tocolytic (stops uterine contractions) Can cause tachycardia (should not be given to pts with cardiac hx)
52
indomethacin
NSAID (blocks production of prostaglandins) Shouldn’t be given after 32 weeks (premature closure of ductus arteriosus
53
for fetus: betamethasone
- for fetal lung maturity - first dose: 12 mg IM initially - 2nd dose: 12mg Im 2hr after 1st - "window" 48 hr after initial dose
54
Amniocentesis
(aspiration of amniotic fluid by insertion of needle transabdominally)
55
Amniocentesis weeks gestation
After 14 weeks | (between 15- 20 weeks)
56
Amniocentesis interpretation of findings
- Presence of Alpha fetaloprotein could mean chromosomal anomaly or neural tube defect - Can also test fetal lung maturity - Fetal hemolytic disease
57
Maternal Alpha Fetoprotein
blood test
58
Maternal Alpha Fetoprotein weeks
16-18
59
Maternal Alpha Fetoprotein interpretation of findings
High levels- neural tube defect or open abd defect Low levels- down syndrome Screening tool- further test needed if positive
60
nonstress test
Non invasive fetal monitoring with external doppler transducer (for FHT) and tocotransducer (for contractions)
61
nonstress test reactive NST
- 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
nonstress test nonreactive NST
Anything above is not met in 40 min | BPP needed
63
Biophysical Profile (BPP)
Ultrasound to visualize physical and physiological characteristics of the fetus and observe for responses to stimuli
64
Biophysical Profile (BPP) test for
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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